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Objective The relationship between the surgical approach used for hemiarthroplasty and periprosthetic bone mineral density (BMD) is not well understood. We have previously described a decrease in BMD 1 year postoperatively. Here, we assessed the medium-term changes in periprosthetic BMD. Methods We performed a follow-up study of patients with femoral neck fracture (FNF) who underwent uncemented hemiarthoplasty using a direct lateral or anterolateral approach. Dual-energy X-ray absorptiometry (DXA) was used to evaluate the changes in BMD in 23 patients over 5 years. Results A mean 6% loss of total BMD occurred over 1 year, but between 1 and 5 years, BMD was restored to the baseline value. The mean total BMD in the anterolateral group had decreased by 2% after 3 months and 3% after 12 months, and increased by 2% after 5 years, vs . decreases of 7%, 8%, and 3% for the direct lateral group. Between 1 and 5 years, BMD increased in Gruen zones 2, 3, 4, 5, and 6 in both groups. There was a significantly larger increase in zone 4 in the lateral group (4%) than the anterolateral group. Conclusion The surgical approach affects periprosthetic BMD in patients with FNF. Furthermore, BMD is restored to the baseline value 5 years postoperatively. ClinicalTrials.gov registration number: NCT03753100.

IntroductionThe COVID-19 pandemic has significantly impacted the education sector, and this case study examined nearly three hundred PhD supervisors in Norway. The study was driven by the urgent need to better understand the professional, social, and existential conditions faced by doctoral supervisors during extended societal shutdowns. This explorative case study builds on a former study among PhD candidates and investigates the experiences of doctoral supervisors when remote work, digital teaching, and digital supervision suddenly replaced physical presence in the workplace, largely between March 12, 2020, and autumn 2022, due to the COVID-19 pandemic.MethodsA mixed-methods research approach, incorporating formative dialog research and case study design, was employed to bridge the conceptual and contextual understanding of this phenomenon. The primary data sources were a survey (N = 298, 53.7% women, 46.3% men, response rate 80.54%) and semi-structured interviews (with nine PhD supervisors). Supplementary data collection was based on formative dialog research. It included field dialog (four PhD supervision seminars), open survey responses (n = 1,438), one focus group (n = 5), an additional survey (n = 85), and document analysis of PhD policy documents and doctoral supervision seminar evaluations (n = 7). The survey data, interview data, focus group data, and supplementary data focus also retrospectively on the first year of the pandemic and were collected from August 2022 until October 2023.ResultsThe findings from the explorative case study revealed that the PhD supervisors faced numerous challenges during the pandemic, both professionally and personally. For PhD supervisors who extensively worked from home over a long period, the situation created new conditions that affected their job performance. These altered conditions hindered their research capacity, their ability to follow up with their PhD candidates, and their capacity to fulfill other job responsibilities. Although the PhD supervisors received some support during the pandemic, it seems that the incremental measures provided were insufficient.DiscussionThe case study results indicate that it is more important than ever to understand the gap between the formulation, transformation, and realization arenas when distinguishing between incremental, semi-structural changes and fundamental changes in PhD regulations and guidelines brought on by societal crises. This highlights the need for better crisis preparedness at the doctoral level in the years to come.

Abstract Radiomics objectively quantifies image information through numerical metrics known as features. In this study, we investigated the stability of magnetic resonance imaging (MRI)-based radiomics features in rectal cancer using both anatomical MRI and quantitative MRI (qMRI), when different methods to define the tumor volume were used. Second, we evaluated the prognostic value of stable features associated to 5-year progression-free survival (PFS) and overall survival (OS). On a 1.5 T MRI scanner, 81 patients underwent diagnostic MRI, an extended diffusion-weighted sequence with calculation of the apparent diffusion coefficient (ADC) and a multiecho dynamic contrast sequence generating both dynamic contrast-enhanced and dynamic susceptibility contrast (DSC) MR, allowing quantification of Ktrans, blood flow (BF) and area under the DSC curve (AUC). Radiomic features were extracted from T2w images and from ADC, Ktrans, BF and AUC maps. Tumor volumes were defined with three methods; machine learning, deep learning and manual delineations. The interclass correlation coefficient (ICC) assessed the stability of features. Internal validation was performed on 1000 bootstrap resamples in terms of discrimination, calibration and decisional benefit. For each combination of image and volume definition, 94 features were extracted. Features from qMRI contained higher prognostic potential than features from anatomical MRI. When stable features (> 90% ICC) were compared with clinical parameters, qMRI features demonstrated the best prognostic potential. A feature extracted from the DSC MRI parameter BF was associated with both PFS (p = 0.004) and OS (p = 0.004). In summary, stable qMRI-based radiomics features was identified, in particular, a feature based on BF from DSC MRI was associated with both PFS and OS.

Highlights • This is the first study comparing awareness of calling EMS among outpatients and public in sub-Saharan Africa • Awareness of calling EMS or seeking immediate medical services by acute stroke was adequate among both outpatients and public • Predictors of low awareness of both calling EMS and seeking immediate medical assistance were no medical insurance, residing/working together, history of psychiatric diseases, and normal weight • Results call for educational campaigns on awareness of calling EMS/ seeking immediate medical assistance by stroke.

Objectives: Assess the association of hearing on sex‐specific overall mortality and death from acute cardiovascular disease and evaluate if these effects are modulated by postural balance. Study Design: Cohort study. Setting: Otolaryngology department at an academic hospital. Methods: Patients underwent standard clinical examination, laboratory examination including stabilometry and audiometry. Pure tone average on the best hearing ear was calculated from 0.5, 1, 2, and 3 kHz. Cause of death was retrieved from the Norwegian Cause of Death Registry. Results: A total of 1036 patients (58.8% women) were followed for 26 ± 3 years. In Cox regression analyses for overall mortality adjusted for age, past medical history, and vestibular disease, 10 dB increase in hearing threshold was associated with a 14% increase in mortality among men (hazard ratio 95% confidence interval: 1.02‐1.28, P =.02), but no significant association was seen between hearing and mortality in women (0.92‐1.15, P =.60). The same analyses for acute cardiovascular death found that a 10 dB increase in hearing threshold was associated with a 57% increase in hazard ratio in men (1.21‐2.05, P <.001), but no significant effect of hearing on survival was seen in women (P =.71). Adjusting for postural balance did not change the association between hearing and mortality. Conclusion: This study finds hearing threshold is associated with overall mortality and acute cardiovascular death among men, with no such association observed among women. Our findings indicate important differences between men and women and suggest that such differences should be taken into consideration in audiological research. [ABSTRACT FROM AUTHOR]

Abstract Background Orthopaedic footwear can only be effective in preventing diabetic foot ulcers if worn by the patient. Robust data on long‐term wearing time of orthopaedic footwear are not available, and needed to gain more insights into wearing patterns and associated factors (i.e. participants' demographic, disease‐related characteristics, and footwear usability). We aimed to objectively assess long‐term wearing patterns and identify factors associated with wearing orthopaedic footwear in people with diabetes at moderate‐to‐high risk of ulceration. Methods People diagnosed with diabetes mellitus type 1 and 2 with loss of protective sensation and/or peripheral artery disease and prescribed with orthopaedic footwear were included and followed for 12 months. The primary outcome was mean daily wearing time, continuously measured using a temperature sensor inside the footwear (Orthotimer®). Adherence to wearing orthopaedic footwear was calculated as percentage of wearing time of a total assumed 16 h out‐of‐bed daytime, where adherence

Introduction: The COVID-19 pandemic has significantly impacted the education sector, and this case study examined nearly three hundred PhD supervisors in Norway. The study was driven by the urgent need to better understand the professional, social, and existential conditions faced by doctoral supervisors during extended societal shutdowns. This explorative case study builds on a former study among PhD candidates and investigates the experiences of doctoral supervisors when remote work, digital teaching, and digital supervision suddenly replaced physical presence in the workplace, largely between March 12, 2020, and autumn 2022, due to the COVID-19 pandemic. Methods: A mixed-methods research approach, incorporating formative dialog research and case study design, was employed to bridge the conceptual and contextual understanding of this phenomenon. The primary data sources were a survey (N = 298, 53.7% women, 46.3% men, response rate 80.54%) and semistructured interviews (with nine PhD supervisors). Supplementary data collection was based on formative dialog research. It included field dialog (four PhD supervision seminars), open survey responses (n = 1,438), one focus group (n = 5), an additional survey (n = 85), and document analysis of PhD policy documents and doctoral supervision seminar evaluations (n = 7). The survey data, interview data, focus group data, and supplementary data focus also retrospectively on the first year of the pandemic and were collected from August 2022 until October 2023. Results: The findings from the explorative case study revealed that the PhD supervisors faced numerous challenges during the pandemic, both professionally and personally. For PhD supervisors who extensively worked from home over a long period, the situation created new conditions that affected their job performance. These altered conditions hindered their research capacity, their ability to follow up with their PhD candidates, and their capacity to fulfill other job responsibilities. Although the PhD supervisors received some support during the pandemic, it seems that the incremental measures provided were insufficient. Discussion: The case study results indicate that it is more important than ever to understand the gap between the formulation, transformation, and realization arenas when distinguishing between incremental, semi-structural changes and fundamental changes in PhD regulations and guidelines brought on by societal crises. This highlights the need for better crisis preparedness at the doctoral level in the years to come. [ABSTRACT FROM AUTHOR]

Background: Stroke remains the second leading cause of deaths and disability globally, with highest mortality in Africa (low- and middle-income countries). It is crucial for healthcare professionals to have sufficient stroke risk factors' knowledge in order to reduce the stroke burden. Aims: We investigated healthcare professionals' knowledge of modifiable stroke risk factors, and identified demographic factors influencing this knowledge. Methods: In this cross-sectional survey study from Botswana (upper middle-income country), structured questionnaires reflecting recent stroke guidelines were administered to a representative selection of healthcare workers in greater Gaborone. The response rate was 61.4%, comprising 84 doctors, 227 nurses and 33 paramedics. Categorical data were described using percentages and Chi-square tests. Associations between stroke risk factors' knowledge and demographic factors were analyzed with one-way ANOVA using SPSS 25 statistical software. Results: Awareness rate of individual stroke risk factors was highest for hypertension (96.5%), followed by obesity (93.3%), smoking (91.9%), elevated total cholesterol (91.0%), physical inactivity (83.4%), elevated low-density lipoprotein (LDL) cholesterol (81.1%), excessive alcohol drinking (77.0%), and lowest for diabetes (73.3%). For all-8 risk factors, doctors had the highest knowledge, followed by nurses and paramedics lowest (7.11 vs 6.85 vs 6.06, P

Background and purpose: Impulse control disorders (ICDs) are common among Parkinson's disease patients using dopamine agonists. We wanted to determine whether ICD patients have higher dopamine agonist serum concentrations than those without any sign of ICD. Methods: Patients who used either pramipexole or ropinirole depot once daily were screened for ICDs using the validated Questionnaire for Impulsive‐Compulsive Disorders in Parkinson's Disease–Rating Scale. Those who scored above the cut‐off for one or more of the four defined ICDs (gambling, compulsive sexual behavior, compulsive shopping, and binge‐eating) were compared in a case–control study to patients who scored zero points (no evidence of ICD) on the same items. They were examined clinically and evaluated using relevant scales. Three blood samples were taken on the same day: before daily dose, and then 6 and 12 h later. Results: Forty‐six patients were included: 19 ICD‐positive and 27 controls. Ropinirole serum concentrations 6 h after daily intake (Cmax) were higher in the case group compared to the control group, as was the daily ropinirole dosage. No differences were observed in serum concentrations, dosage or total drug exposure for pramipexole. Disease duration and length of dopamine agonist treatment was significantly longer among ICD patients for ropinirole, but not for pramipexole. Conclusions: The use of pramipexole may in itself confer high ICD risk, whereas ICDs among ropinirole users depend more on serum concentration and drug exposure. The pharmacokinetic properties of ropinirole make it challenging to predict its effects on patients, which supports the need for therapeutic drug monitoring to reduce risk of ICD. [ABSTRACT FROM AUTHOR]

Background and purpose — The loss of bone mineral in the proximal femur following hip arthroplasty may increase the fracture risk around uncemented stems. We hypothesized that the surgical approach to the hip might influence bone mineral changes around the femoral stem in patients with a femoral neck fracture (FNF). Patients and methods — This was a pre-specified subgroup analysis (n = 51) of an ongoing randomized trial (n = 120) in patients with FNF. Participants were allocated to an uncemented hemiarthroplasty inserted through a direct lateral (Hardinge) approach or an anterolateral (modified Watson-Jones) approach. The 51 patients (mean age 83 (70–90) years, 33 women) were measured by dual-energy X-ray absorptiometry (DXA) to assess changes in periprosthetic bone mineral density (BMD). Results — The mean change in total BMD differed between groups at 12 months in favor of the anterolateral group (4.8%, 95% CI 0.0–9.6; p = 0.05). DXA at 3 months displayed BMD loss in the proximal Gruen zones in the lateral group compared with the anterolateral group. Zone 1 (–5.0% vs. 2.7%), zone 2 (–4.3% vs. 4.1%), zone 6 (–6.5% vs. 0.0%) and zone 7 (–11% vs. –2.4%, all p < 0.05). Interpretation — DXA measurements in this study indicate that surgical approach to the hip influences periprosthetic BMD. Clinical implications remain uncertain. Our conclusions should be interpreted with caution as we did not perform adjustments for multiple tests, possibly leading to inflation of false-positive findings.

Allison A Vanderbilt,1 Scott M Pappada,2 Howard Stein,3 David Harper,4 Thomas J Papadimos5 1Department of Family Medicine, 2Department of Anesthesiology, College of Medicine and Life Sciences, University of Toledo, 3Department of Pediatrics, ProMedica Toledo Children’s Hospital, 4Department of Obstetrics and Gynecology, ProMedica Toledo Hospital, 5Department of Anesthesiology, College of Medicine and the Life Sciences, University of Toledo, Toledo, OH, USA Abstract: Hospitals have struggled for years regarding the handoff process of communicating patient information from one health care professional to another. Ineffective handoff communication is recognized as a serious patient safety risk within the health care community. It is essential to take communication into consideration when examining the safety of neonates who require immediate medical attention after birth; effective communication is vital for positive patient outcomes, especially with neonates in a delivery room setting. Teamwork and effective communication across the health care continuum are essential for providing efficient, quality care that leads to favorable patient outcomes. Interprofessional simulation and team training can benefit health care professionals by improving interprofessional competence, defined as one’s knowledge of other professionals including an understanding of their training and skillsets, and role clarity. Interprofessional teams that include members with specialization in obstetrics, gynecology, and neonatology have the potential to considerably benefit from training effective handoff and communication practices that would ensure the safety of the neonate upon birth. We must strive to provide the most comprehensive systematic, standardized, interprofessional handoff communication training sessions for such teams, through Graduate Medical Education and Continuing Medical Education that will meet the needs across the educational continuum. Keywords: interprofessional health care teams, handoffs, neonates, patient safety, communication

Trawl-caught fish are frequently associated with deteriorated catch quality. This study presents a new dual sequential codend concept with the aim of improving the quality of trawl-caught fish by minimizing the frequency and severity of catch damage. During towing, the fish are retained in an anterior codend segment with the legislated mesh size. A quality improving codend segment, is attached to the aft part of the first codend segment. Its entrance is closed during the towing phase and opened at a predefined depth during haul-back. Comparing the quality of cod (Gadus morhua L.) retained in the sequential codend with cod caught in a conventional codend, demonstrated a significant improvement in the catch quality, i.e. reduction in catch damages. Cod caught in a conventional codend had only a 3.6% probability of being without visually detectable catch damage. The probability for catching cod without catch damage was five times higher when using the dual sequential codend. Furthermore, cod caught in the sequential codend had a significantly reduced probability of incurring specific catch damage, such as gear marks, poor exsanguination, ecchymosis, and skin abrasions.