Secondary resurfacing of the patella in total knee arthroplasty

Anterior knee pain following primary total knee arthroplasty is common and can be difficult to treat satisfactorily. We reviewed 28 consecutive patients (29 knees) who underwent secondary resurfacing of the patella for persistent anterior knee pain and report on the results. Mean follow-up was 28 months (range12-61) with no cases lost to follow-up. Oxford knee scores, range of motion, the patient's assessment of outcome and overall satisfaction were recorded. Seventeen out of 19 (59%) felt their knee was better following patellar resurfacing, 10 out of 29 (34%) felt it was the same and two out of 29 (7%) felt it was worse. There was a significant improvement in Oxford knee scores (p < 0.001) and significant increase in patient satisfaction (p < 0.001) following secondary resurfacing. While secondary resurfacing of the patella does not provide the solution for every case of anterior knee pain following total knee joint replacement, in greater than 50% of cases it can be effective at relieving symptoms and in this series carries a low risk of worsening symptoms or complications

Inverting the bad debt ladder: Credit self-efficacy and healthier financial state

Levels of indebtedness amongst South African consumers are increasing year on year and the formal lending system is not structured or incentivised to reverse this. In lieu of fundamental change in regulation and to current institutionalised lending and debt collection practices, the best way to reverse the negative cycle of ever-increasing indebtedness is by shifting control to the consumer themselves. Industry collection mechanisms are functional and blunt, treating any arrear debt as ‘bad' and by association all indebted consumers are labelled ‘bad' with no recognition of the circumstance an individual might find themselves in. Covid has had a devastating effect on consumer psychology and the ability for individuals and households to meet their financial obligations. A more empathy-led approach to supporting indebted consumers is necessary. The aim of this study is to establish the most important factors within credit self-efficacy that enable certain consumers to make better credit decisions and reverse the downward, self-reinforcing spiral to greater indebtedness, It has supported the development of a business model aimed at making it attractive and profitable for the lenders to actively support the enablement of consumer capability in relation to credit. Using an online survey, a quota-controlled sample of n=874 consumers was achieved, adequately representing the adult population active in the formal South African credit market. Through the development of a structured equation model using n=794 of the collected data records, the study has found that the typical treatment of the indebted is ineffectual in helping consumers return to a healthier financial state. The perception that consumer desire of material goods alone drives poor credit behaviour and therefore greater levels of indebtedness is unfounded, as is the idea of profligate spending and its impact on credit behaviour. Living a good lifestyle is important to consumers and does affect credit behaviour but this does not translate into a significant effect on financial state. Rather, it is the combination of financial credit self-efficacy, financial confidence and financial management, as composite credit self-efficacy, that has a significant and strong influence on credit behaviour. In turn, credit behaviour as a mediating variable significantly and strongly influences financial state, more so than the direct effect of composite credit self-efficacy. Financial state also has a significant and extremely strong influence on composite credit self-efficacy, proving that a healthier financial state actually empowers greater consumer self-efficacy in relation to credit and financial matters. It is therefore incumbent on lenders of credit to have a more sensitive appreciation of consumer context and support consumers along their whole credit journey, by better understanding their personal circumstances, related psychosocial factors and how this affects their level of composite credit self-efficacy and credit behaviour. Future studies should concentrate on how credit self-efficacy can be instilled and tracked from an early age, especially amongst consumers who are new to the credit market, as data suggests that a single event can trigger a life-long journey down a ladder of increasing indebtedness

Human Immunodeficiency Virus disease and cardiac surgery – where are we?

Uncertainties concerning the effects of cardiopulmonary bypass, outcome and possibility of operator injury slowed progress in cardiac surgery in the HIV-infected patient. Severely ill patients, some with AIDS and others probably with AIDS, formed the basis of early reports; it was shown they could be taken through surgery satisfactorily. Following the advent of antiretroviral monotherapy – zidovudine, an NRTI – in 1987, and dual therapy in the early 1990s with NRTIs, the addition of protease inhibitors (PI) in 1995, although a double-edged sword, led to triple therapy/HAART, (2 NRTIs and a PI) and startling improvement in morbidity and mortality in markedly compromised HIV patients. Yet, it was only in 2003 when sizeable reports carrying ARV usage began to emerge. Intravenous drug addiction causing left-sided valvular heart disease was initially responsible for most cases, but there was now an increase in coronary artery disease (CAD) in young patients, blamed partly on lipid disturbances caused by PI. With an ARV rollout in South Africa delayed to 2004, and PIs only used in second line therapy in State-administered treatment, the increase in coronary artery disease has not been noted. The need for surgery in pericardial disease is rare. Paediatric cardiac surgery has been rarely reported, but is locally carried out; a new approach to medical management of these children should lead to more frequent surgery. Heart transplantation lags far behind solid organ transplantation, but there are indications that it will be more readily accepted. Certain vascular pathologies appear to be peculiar to HIV, with the virus itself being able to enter vessel walls with evolution of vascular disease. PIs would appear to accelerate coronary artery disease, as seen in younger HIV patients, who develop abnormal lipid profi les. The approach to cardiac surgery in most cardiac teaching units is looked at. Many answers have been found, but new issues have also arisen, as in relation to ARV’s and CAD. Most importantly, attitudes are changing: some would accept selected patients with AIDS not receiving ARVs. Very good results have followed surgery in patients who have suffered AIDS defining conditions but are stable on ARVs

Structural barriers to transformational leadership and the influence of internal organisational context

This thesis explores the potential structural barriers to transformational leadership and the influence of organisational context. Qualitative research was undertaken across two case study firms using grounded research (Glaser & Strauss, 1967; Whiteley, 2004).A number of themes emerged which collectively describe a range of structural barriers to transformational leadership. The empirical evidence of this research highlights the structural barriers and the influence of organisational context on transformational leadership. The themes that emerged and are discussed in this thesis include: understanding and influence of the strategic context; clarity of direction; organisational design; control systems; role context; the change dynamic within the organisation; the degree of empowerment; the organisational culture; the relational context; and the lack of time.From these emergent themes and incorporating the extant literature a number of second order insights also emerged. In particular, the thesis examines the interplay between the levels of work and the nature of transformational leadership; the notion of ‘nested leadership’ where the leader’s leader plays a much stronger role than simple role modelling; and the emergence of a new holism, wherein the dynamic interplay between transactional and transformational leadership is exploredThe research confirms what Fiedler and others have suggested: “we can design situations that allow leaders to utilize their intellectual abilities, expertise and experience more effectively” (Fiedler, 1996, p. 249)

The diagnostic performance of routinely acquired and reported computed tomography imaging in patients presenting with suspected pleural malignancy

Objectives: Contrast-enhanced computed tomography (CT) provides essential cross-sectional imaging data in patients with suspected pleural malignancy (PM). The performance of CT in routine practice may be lower than in previously reported research. We assessed this relative to ‘real-life’ factors including use of early arterial-phase contrast enhancement (by CT pulmonary angiography (CTPA)) and non-specialist radiology reporting. Materials and methods: Routinely acquired and reported CT scans in patients recruited to the DIAPHRAGM study (a prospective, multi-centre observational study of mesothelioma biomarkers) between January 2014 and April 2016 were retrospectively reviewed. CT reports were classified as malignant if they included specific terms e.g. “suspicious of malignancy”, “stage M1a” and benign if others were used e.g. “indeterminate”, “no cause identified”. All patients followed a standard diagnostic algorithm. The diagnostic performance of CT (overall and based on the above factors) was assessed using 2 × 2 Contingency Tables. Results: 30/345 (9%) eligible patients were excluded (non-contrast (n = 13) or non-contiguous CT (n = 4), incomplete follow-up (n = 13)). 195/315 (62%) patients studied had PM; 90% were cyto-histologically confirmed. 172/315 (55%) presented as an acute admission, of whom 31/172 (18%) had CTPA. Overall, CT sensitivity was 58% (95% CI 51–65%); specificity was 80% (95% CI 72–87%). Sensitivity of CTPA (performed in 31/315 (10%)) was lower (27% (95% CI 9–53%)) than venous-phase CT (61% (95% CI 53–68%) p = 0.0056). Sensitivity of specialist thoracic radiologist reporting was higher (68% (95% CI 55–79%)) than non-specialist reporting (53% (95% CI 44–62%) p = 0.0488). Specificity was not significantly different. Conclusion: The diagnostic performance of CT in routine clinical practice is insufficient to exclude or confirm PM. A benign CT report should not dissuade pleural sampling where the presence of primary or secondary pleural malignancy would alter management. Sensitivity is lower with non-thoracic radiology reporting and particularly low using CTPA

Using near-infrared reflectance spectroscopy to predict the digestible protein and digestible energy values of diets when fed to barramundi, Lates calcarifer

This study examined the potential of using near-infrared spectroscopy (NIRS) to predict nutrient digestibility parameters (digestible protein and digestible energy) of compound diets when fed to barramundi. A series of 60 diets were assessed for their protein and energy digestibilities in a series of five experiments over a 5-year period from 2009 to 2014. Considerable variance was observed in the digestibility parameters of diets across the experiments, providing a suitable range in diet digestible protein and digestible energy values from which to develop a NIRS calibration. Samples of the same diets were also scanned using a diode array near-infrared spectrophotometer (DA-NIRS). The spectra were obtained by the DA-NIRS and were chemometrically calibrated against the digestible value data using multivariate analysis software. The results in terms of standard error of cross-validation (SECV), residual prediction deviation (RPD) and correlation coefficient (R2) show good relationships (R2 > 0.8) between the predicted and observed parameters for both the digestible protein and digestible energy parameters assessed. This study therefore demonstrates that it is possible to use NIRS technology to provide rapid estimates of the digestible protein and digestible energy values of compound diets for barramundi in near real time.&nbsp

Critical variability exists in the digestible value of raw materials fed to black tiger shrimp, Penaeus monodon: The characterisation and digestibility assessment of a series of research and commercial raw materials

The digestibility of a suite of raw materials was determined when fed to black tiger shrimp (Penaeus monodon) in a series of three experiments. A total of 29 commercial and research raw materials were evaluated using the diet replacement digestibility method. Each of the reference and test diets were fed to tanks of shrimp for one-week prior to commencing faecal collection. The collected faecal samples were kept separate from any feed residue through using a discrete feeding period, after which uneaten feed was removed before a separate faecal collecting period. The same reference diet and soy protein concentrate diet were used across each of the three experiments and demonstrated consistent digestibility using this method. Most raw materials demonstrated some utility for use in diets for shrimp, with digestible protein or energy values >0.800. However, there were some raw materials (e.G. camelina meal) that provided very little nutritive value for shrimp. This study presents data on the digestibility and digestible nutrient content of a wide variety of raw materials, providing a clear basis for progressing to formulating shrimp diets on a digestible protein and energy basis, thereby optimising dietary formulation, maximising ingredient utilisation and reducing impacts of uneaten feed

Efficacy and cost effectiveness of bronchial arterial embolisation in the treatment of major haemoptysis

Objective. To determine the efficacy and cost-effectiveness of bronchial artery embolisation (BAE) in the treatment of major and massive haemop tysis in HIV-positive and negative patients with pulmonary inflammatory disease.Methods. A retrospective review of patients admitted over a period of 24 months to Wentworth Hospital with major haemoptysis treated using BAE.Results. Eighty-seven patients were treated (77 males, 10 females). Bilateral disease was present in 50 patients (57%). Thirty-two patients were lllV-positive (37%). Embolisation was successfully performed in 77 patients (88.5%), and failed for technical reasons in 10 patients (11 .5%). There was only one procedural complication. Fifty-seven patients had a successful outcome, with cessation of haemoptysis within 24 hours (66.5%). Haemoptysis continued in 30 patients (34%) (20 patients embolised and the 10 patients who had failed procedures). Fourteen of these patients (16%) required lobectomy or pneumonectomy as an emergency procedure. Five patients (5.7%) died from respiratory failure or pulmonary haemorrhage. Twenty-four HIV-positive patients were successfully embolised. Costing of BAE, including a 2-day ICU and 3-day ward stay, was R6 720; together with surgical resection the cost was R14 170.Conclusions. BAE is an effective treatment for major and/or massive haemoptysis in patients with pulmonary inflammatory disease who are not surgical candidates. Patients who are HIV-positive are able to tolerate the procedure well

A study of the discrete and interactive effects of different polysaccharides on the digestibility of diets fed to barramundi (Lates calcarifer)

This study examined the single, paired and combined inclusion effect of a range of different polysaccharide types on the dry matter, protein and energy digestibility of diets fed to barramundi (Lates calcarifer). The different polysaccharides included pregelled starch, cellulose, lignin and pectin. There were significant differences among the digestibility parameters of the diets with the different inclusion levels of each of the different polysaccharide types. Using a manova analysis, effects were noted for polysaccharide type, inclusion level and interaction terms on the digestibilities of dry matter, protein and energy. Cellulose addition resulted in a reduction in both dry matter and energy that was largely commensurate with its inclusion level, but its effect on protein digestibility was marginal. Starch had the least effect on any of the digestibility parameters of all the polysaccharide types examined. Pectin had the largest effect on dry matter, while lignin had the greatest impact on diet protein and energy digestion. In the diets with paired combinations of polysaccharides, lignin and pectin were responsible for negatively synergistic interactions in all digestibility parameters. These results show that different polysaccharide classes can have distinctly different effects on diet digestibility parameters. © 2015 John Wiley & Sons Ltd