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Knee arthritis occupies a significant proportion of the musculoskeletal burden in the UK. Total knee arthroplasty currently comprises the mainstay of treatment. There has been a shift towards treating isolated unicompartmental osteoarthritis with bone-preserving surgical techniques, in the form of realignment osteotomy or unicompartmental arthroplasty. There are significant data regarding the survivorship of unicompartmental knee arthroplasty from the National Joint Registry data. Similar registry data are not available for osteotomy surgery yet, but the evidence suggests that unicompartmental knee arthroplasty has greater survivorship. Osteotomies can, however, deliver higher functional return. For both techniques to succeed, it is imperative that rigorous surgical decision-making, with regards to patient selection, should be followed. This paper discusses the basis for these principles and their importance in delivering optimal care. Often, these two surgical techniques are promoted as being mutually exclusive; this paper argues that, in fact, they are part of a complementary algorithm that can deliver the best outcome to the appropriately selected patient. [ABSTRACT FROM AUTHOR]

Abstract: The long‐standing debate into the potential benefit of developing mathematical thinking skills through learning to program has been reignited with the widespread introduction of programming in schools across many countries, including England where it is a statutory requirement for all pupils to be taught programming from 5 years old. Algorithm is introduced early in the English computing curriculum, yet there is limited knowledge of how young pupils view this concept. This paper explores pupils' (aged 10–11) understandings of algorithm following their engagement with 1 year of ScratchMaths, a curriculum designed to develop computational and mathematical thinking skills through learning to program. A total of 181 pupils from 6 schools undertook a set of written tasks to assess their interpretations and evaluations of different algorithms that solve the same problem, with a subset of these pupils subsequently interviewed to probe their understandings in greater depth. We discuss the different approaches identified, the evaluation criteria they used, and the aspects of the concept that pupils found intuitive or challenging, such as simplification and abstraction. The paper ends with some reflections on the implications of the research, concluding with a set of recommendations for pedagogy in developing primary pupils' algorithmic thinking. [ABSTRACT FROM AUTHOR]

Background: The aim of this study was to update and refine an algorithm, originally developed in Canada, to assist care home staff to manage residents with suspected infection in the United Kingdom care home setting. The infections of interest were urinary tract infections, respiratory tract infections and skin and soft tissue infection.Method: We used a multi-faceted process involving a literature review, consensus meeting [nominal group technique involving general practitioners (GPs) and specialists in geriatric medicine and clinical microbiology], focus groups (care home staff and resident family members) and interviews (GPs), alongside continual iterative internal review and analysis within the research team.Results: Six publications were identified in the literature which met inclusion criteria. These were used to update the algorithm which was presented to a consensus meeting (four participants all with a medical background) which discussed and agreed to inclusion of signs and symptoms, and the algorithm format. Focus groups and interview participants could see the value in the algorithm, and staff often reported that it reflected their usual practice. There were also interesting contrasts between evidence and usual practice informed by experience. Through continual iterative review and analysis, the final algorithm was finally presented in a format which described management of the three infections in terms of initial assessment of the resident, observation of the resident and action by the care home staff.Conclusions: This study has resulted in an updated algorithm targeting key infections in care home residents which should be considered for implementation into everyday practice. [ABSTRACT FROM AUTHOR]

A significant set of epistemic and political transformations are taking place as states and societies begin to understand themselves and their problems through the paradigm of deep neural network algorithms. A machine learning political order does not merely change the political technologies of governance, but is itself a reordering of politics, of what the political can be. When algorithmic systems reduce the pluridimensionality of politics to the output of a model, they simultaneously foreclose the potential for other political claims to be made and alternative political projects to be built. More than this foreclosure, a machine learning political order actively profits and learns from the fracturing of communities and the destabilising of democratic rights. The transformation from rules-based algorithms to deep learning models has paralleled the undoing of rules-based social and international orders – from the use of machine learning in the campaigns of the UK EU referendum, to the trialling of algorithmic immigration and welfare systems, and the use of deep learning in the COVID-19 pandemic – with political problems becoming reconfigured as machine learning problems. Machine learning political orders decouple their attributes, features and clusters from underlying social values, no longer tethered to notions of good governance or a good society, but searching instead for the optimal function of abstract representations of data. [ABSTRACT FROM AUTHOR]

Background: Almost 50,000 men in the United Kingdom (UK) are diagnosed each year with prostate cancer (PCa). Secondary referrals for investigations rely on serum prostate-specific antigen (PSA) levels and digital rectal examination. However, both tests lack sensitivity and specificity, resulting in unnecessary referrals to secondary care for costly and invasive biopsies. Materials and Methods: Serum samples and clinical information were collected from N = 125 age-matched patients (n = 61 non-PCa and n = 64 PCa) and analyzed using Biochip Array Technology on high-sensitivity cytokine array I (IL-2, IL-4, IL-6, IL-8, IL-10, IL-1α, IL-1β, TNFα, MCP-1, INFγ, EGF, and VEGF), cerebral array II (CRP, D-dimer, neuron-specific enolase, and sTNFR1), and tumor PSA oncology array (fPSA, tPSA, and CEA). Results: The data showed that 11/19 (68.8%) markers were significantly different between the non-PCa and the PCa patients. A combination of EGF, log10 IL-8, log10 MCP-1, and log10 tPSA significantly improved the predictive potential of tPSA alone to identify patients with PCa (DeLong, p < 0.001). This marker combination had an increased area under the receiver operator characteristic (0.860 vs. 0.700), sensitivity (78.7 vs. 68.9%), specificity (76.5 vs. 67.2%), PPV (76.2 vs. 66.7%), and NPV (79.0 vs. 69.4%) compared with tPSA. Conclusions: The novel combination of serum markers identified in this study could be employed to help triage patients into "low-" and "high-risk" categories, allowing general practitioners to improve the management of patients in primary care settings and potentially reducing the number of referrals for unnecessary, invasive, and costly treatments. [ABSTRACT FROM AUTHOR]

Abstract: Introduction: Helicopter emergency medical services play a valuable role in the transfer of critically ill patients. This paper reviews the role of air ambulance services in the provision of regional burns care and suggests guidelines for their use. Methods: A retrospective review of patients treated at the Midlands Adult Burns Centre over a 3-year period. Results: 27 adult burns patients were transported by air ambulance during the study period. Patients were aged 19–89 years (average 41.3 years) with an estimated burn size of 5–70% TBSA. Distance travelled was 11–79miles (average 41.2miles). All patients were appropriately referred to the burns centre according to national referral guidelines but in 7 cases (26%) it was felt that transport by air ambulance was not clinically indicated and land transfer would have been safe and appropriate. Conclusion: Air ambulances offer a fast and effective means of transferring patients to a regional burns centre in selected cases. There is limited data for the beneficial effects of helicopters and survival benefit is seen only in the most severely injured patients. We suggest criteria for the use of air ambulances in burns patients in order to maximise the benefit and reduce unnecessary flights. [Copyright &y& Elsevier]

This article outlines a strategic process for the evaluation of wound management products and the development of an algorithm as an implementation model for wound management. Wound management is an increasingly complex process given the variety of interactive dressings and other devices available. This article discusses the procurement process, access to wound management dressings and the use of wound management formularies within the UK. We conclude that the current commissioners of tissue viability within healthcare organisations need to adopt a proactive approach to ensure appropriate formulary evaluation and product selection, in order to achieve the most beneficial clinical and financial outcomes. [ABSTRACT FROM AUTHOR]