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Background We aimed to assess the validity of magnetic resonance imaging (MRI) in assessing the subcorocoid space and determine the validity of novel sagittal plane subcorocoid space measurements. Methods We assessed 33 arthroscopically proven subscapularis tears with MRIs compared to 33 (instability) controls with normal subscapularis tendons. Three examiners analyzed MRIs for seven static indices of corocoid morphology, in axial and sagittal planes. We explored reviewer variation using intraclass correlation coefficients (ICC) and differences between the two groups was explored using t-tests. Results Groups were similar in characteristics but different in age (cases = 53, controls = 23). ICC showed good (2/7) or excellent (5/7) reliability. Small differences(<1.6 mm) were identified between subscapularis tears and controls in coraco–humeral distance, in axial (p = 0.092) and sagittal planes (p = 0.045). There were statistically significant differences between groups when analyzing the angular projection of the coracoid from the glenoid, in both sagittal (p < 0.0001) and axial planes (p = 0.045). Conclusions Acute inferior angulation of the corocoid in the sagittal plane may be associated with subscapularis tears. Static indices are measured within the scapula and not affected by arm position. MRI reliably provided a platform to assess the coracoid. Based on this, we currently consider corocoplasty in patients with subscapularis tears and a sagittal coroco–glenoid angle <60o to reduce potential impingement. [ABSTRACT FROM AUTHOR]

Avulsion, epidermal marsupialization, and infection cause failure at the skin-material interface. A robust interface would permit implantable robotics, prosthetics, and other medical devices; reconstruction of surgical defects, and long-term access to blood vessels and body cavities. Torus-shaped cap-scaffold structures were designed to work in conjunction with negative pressure to address the three causes of failure. Six wounds were made on the backs of each of four 3-month old pigs. Four unmodified (no caps) scaffolds were implanted along with 20 cap-scaffolds. Collagen type 4 was attached to 21 implants. Negative pressure then was applied. Structures were explanted and assessed histologically at day 7 and day 28. At day 28, there was close tissue apposition to scaffolds, without detectable reactions from defensive or interfering cells. Three cap-scaffolds explanted at day 28 showed likely attachment of epidermis to the cap or cap-scaffold junction, without deeper marsupialization. The combination of toric-shaped cap-scaffolds with negative pressure appears to be an intrinsically biocompatible system, enabling a robust skin-material interface. © 2016 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater, 105B: 1307-1318, 2017. [ABSTRACT FROM AUTHOR]

Introduction: Farm workers are at high risk for injuries, and epidemiological data are needed to plan resource allocation. Objective: This study identified regions with high farm‐related injury rates in the Barwon South West region of Victoria, Australia, for residents aged ≥50 yr. Design: Retrospective synthesis using electronic medical records of emergency presentations occurring during 2017–2019 inclusive for Local Government Areas (LGA) in the study region. For each LGA, age‐standardised incidence rates (per 1000 population/year) were calculated. Findings: For men and women combined, there were 31 218 emergency presentations for any injury, and 1150 (3.68%) of these were farm‐related. The overall age‐standardised rate for farm‐related injury presentations was 2.6 (95% CI 2.4–2.7); men had a higher rate than women (4.1, 95% CI 3.9–4.4 versus 1.2, 95% CI 1.0–1.3, respectively). For individual LGAs, the highest rates of farm‐related emergency presentations occurred in Moyne and Southern Grampians, both rural LGAs. Approximately two‐thirds of farm‐related injuries occurred during work activities (65.0%), and most individuals arrived at the hospital by transport classified as "other" (including private car, 83.3%). There were also several common injury causes identified: "other animal related injury" (20.2%), "cutting, piercing object" (19.5%), "fall ⟨1 m" (13.1%), and "struck by or collision with object" (12.5%). Few injuries were caused by machinery (1.7%) and these occurred mainly in the LGA of Moyne (65%). Discussion and Conclusion: This study provides data to inform future research and resource allocation for the prevention of farm‐related injuries. [ABSTRACT FROM AUTHOR]

Objective Methods Results Conclusion To examine gender differences in Australian football (AF)‐related concussion presentations to EDs in regional Australia.A prospective observational study of patients presenting to 1 of the 10 EDs in Western Victoria, Australia, with an AF‐related concussion was conducted. Patients were part of a larger study investigating AF injuries over a complete AF season, including pre‐season training and practice matches. Information regarding concussion injuries was extracted from patient medical records, including clinical features, concurrent injuries, mechanism and context of injury. Female and male data were compared with chi‐squared and Fisher's exact tests. P < 0.05 was considered significant.From the original cohort of 1635 patients with AF‐related injuries (242 female and 1393 male), 231 (14.1%) patients were diagnosed with concussion. Thirty‐eight (15.7%) females had concussions versus 193 (13.9%) males (P > 0.05). Females over the age of 16 were more likely to be concussed than males in the same age range (females n = 26, 68.4% vs males n = 94, 48.7%; P = 0.026). Neurosurgically significant head injury was rare (one case). Similar rates of concurrent injury were found between females 15 (39.5%) and males 64 (33.2%), with neck injury the single most common in 24 (10.3%) concussions. Sixty‐nine patients (29%) were admitted for observation or to await the results of scans. The majority of concussions occurred in match play (87.9%). Females were more likely injured in contested ball situations (63.2% vs 37.3%; P < 0.05).Concussion rates for community‐level AF presentations to regional EDs were similar between genders. Serious head injury was rare, although hospital admission for observation was common. Concurrent injuries were common, with associated neck injury most often identified. Match play accounted for the majority of head injuries. [ABSTRACT FROM AUTHOR]

Background: Patient outcomes following low-trauma hip fracture are suboptimal resulting in increased healthcare costs and poor functional outcomes at 1 year. Providing early and intensive in-hospital physiotherapy could help improve patient outcomes and reduce costs following hip fracture surgery. The HIP fracture Supplemental Therapy to Enhance Recovery (HIPSTER) trial will compare usual care physiotherapy to intensive in-hospital physiotherapy for patients following hip fracture surgery. The complex environments in which the intervention is implemented present unique contextual challenges that may impact intervention effectiveness. This study aims to complete a process evaluation to identify barriers and facilitators to implementation and explore the patient, carer and clinician experience of intensive therapy following hip fracture surgery. Methods and analysis: The process evaluation is embedded within a two-arm randomised, controlled, assessor-blinded trial recruiting 620 participants from eight Australian hospitals who have had surgery for a hip fracture sustained via a low-trauma injury. A theory-based mixed method process evaluation will be completed in tandem with the HIPSTER trial. Patient and carer semi-structured interviews will be completed at 6 weeks following hip fracture surgery. The clinician experience will be explored through online surveys completed pre- and post-implementation of intensive therapy and mapped to domains of the Theoretical Domains Framework (TDF). Translation and behaviour change success will be assessed using the Reach Effectiveness-Adoption Implementation Maintenance (RE-AIM) framework and a combination of qualitative and quantitative data collection methods. These data will assist with the development of an Implementation Toolkit aiding future translation into practice. Discussion: The embedded process evaluation will help understand the interplay between the implementation context and the intensive therapy intervention following surgery for low-trauma hip fracture. Understanding these mechanisms, if effective, will assist with transferability into other contexts and wider translation into practice. Trial registration: ACTRN 12622001442796. [ABSTRACT FROM AUTHOR]

Background: Tourniquet use during total knee replacement is common, yet uncertainty exists regarding its benefits and harms. The primary aim of the current study is to investigate whether tourniquet use during total knee replacement leads to greater reduction in quadriceps strength than non-tourniquet use at three months post-surgery. Secondary aims include investigating the effects of tourniquet use on: quadriceps strength at day 2 and 5, and 12 months post-surgery; pain and analgesia requirements; self-reported physical function and quality of life; blood loss and replacement; surgeon satisfaction with the intra-operative visual field; operation and anaesthetic time; complications; cement mantle quality; patient satisfaction; and hospital length of stay.Methods: The study is a single centre, parallel-arm, double-blind (participant and assessor), randomised trial with 1:1 random allocation. Participants will be undergo total knee replacement with or without tourniquet. Linear mixed models will be used for group comparisons of continuous outcomes available at multiple timepoints. Other continuous outcomes that are assessed at baseline and once/twice at follow-up will be analysed using linear regression. Categorical outcomes will be analysed using logistic regression models.Discussion: This study will provide high-quality evidence regarding the effects of tourniquet use during total knee replacement, which can be used to inform surgeon decision-making.Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12618000425291 . Retrospectively registered 23 March 2018. [ABSTRACT FROM AUTHOR]

On September 31, 1968, young men in their 20's and 30's assembled at the Syracuse University Conference Center at Lake Minnowbrook in the Adirondacks to assess the contemporary dimensions of public administration. The participants, representing 27 different universities and agencies across the country, devoted three-and-a-half days to free and essentially unstructured discussion. The papers and some additional readings from the Public Administration Review were mailed in advance. Topics included normative theory, empirical theory, comparative public administration, administrative decision making, organizational theory,, collective negotiations in the public service and higher education for public service. The focus of public administration has been and remains public-administered organizations, but much greater emphasis and analysis should be devoted to the political and public context in which these organizations function. Public organizations must find additional supporters and resources to cope with the multiple revolutions now shaking them.

Post-Operative Cognitive Dysfunction (POCD) is a highly prevalent condition with significant clinical, social and financial impacts for patients and their communities. The underlying pathophysiology is becoming increasingly understood, with the role of neuroinflammation and oxidative stress secondary to surgery and anaesthesia strongly implicated. This review aims to describe the putative mechanisms by which surgery-induced inflammation produces cognitive sequelae, with a focus on identifying potential novel therapies based upon their ability to modify these pathways. [ABSTRACT FROM AUTHOR]

Background: The stemmed anatomic total shoulder arthroplasty is the gold standard in the treatment of glenohumeral osteoarthritis. However, the use of stemless total shoulder arthroplasties has increased in recent years. The number of revision procedures are relatively low, and therefore it has been recommended that national joint replacement registries should collaborate when comparing revision rates. Therefore, we aimed to compare the revision rates of stemmed and stemless TSA used for the diagnosis of glenohumeral osteoarthritis using data from both the Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR) and the Danish Shoulder Arthroplasty Registry (DSR)., Methods: We included all patients who were registered in the AOANJRR and the DSR from January 1, 2012, to December 2021 with an anatomic total shoulder arthroplasty used for osteoarthritis. Revision for any reason was used as the primary outcome. We used the Kaplan-Meier method to illustrate the cumulative revision rates and a multivariate cox regression model to calculate the hazard ratios. All analyses were performed separately for data from AOANJRR and DSR, and the results were then reported using a qualitative approach., Results: A total of 13,066 arthroplasties from AOANJRR and 2882 arthroplasties from DSR were included. The hazard ratio for revision of stemmed TSA with stemless TSA as reference, adjusted for age and gender, was 1.67 (95% confidence interval [CI] 1.34-2.09, P < .001) in AOANJRR and 0.57 (95% CI 0.36-0.89, P = .014) in DSR. When including glenoid type and fixation, surface bearing (only in AOANJRR), and hospital volume in the cox regression model, the hazard ratio for revision of stemmed TSA compared to stemless TSA was 1.22 (95% CI 0.85-1.75, P = .286) in AOANJRR and 1.50 (95% CI 0.91-2.45, P = .109) in DSR. The adjusted hazard ratio for revision of total shoulder arthroplasties with metal-backed glenoid components compared to all-polyethylene glenoid components was 2.54 (95% CI 1.70-3.79, P < .001) in AOANJRR and 4.1 (95% CI 1.92-8.58, P < .001) in DSR., Conclusion: Based on data from 2 national shoulder arthroplasty registries, we found no significant difference in risk of revision between stemmed and stemless total shoulder arthroplasties after adjusting for the type of glenoid component. We advocate that metal-backed glenoid components should be used with caution and not on a routine basis., (Copyright © 2024 The Author(s). Published by Elsevier Inc. All rights reserved.)

Background: We compared the rate of all-cause revision of 2 classes of primary anatomic shoulder arthroplasty, stemmed (stTSA) and stemless (slTSA), undertaken with cemented all-polyethylene glenoid components., Methods: A large national arthroplasty registry identified 2 cohort groups for comparison, stTSA and l undertaken for all diagnoses between January 1, 2011, and December 31, 2021. A subanalysis from January 1, 2017, allowed capturing of additional patient demographics including American Society of Anesthesiologists score, body mass index, and glenoid morphology. The cumulative percent revision (CPR) was determined using Kaplan-Meier estimates of survivorship and hazard ratios (HR) from Cox proportional hazard models adjusted for age and gender., Results: Of the 7995 stTSA procedures, the CPR at 9 years was 5.6% (95% confidence interval [CI]: 5.0, 6.4), and for 3156 slTSA procedures, the CPR was 4.4% (95% CI: 3.6, 5.5). There was no significant difference in the rate of revision between the study groups (HR = 0.76 [95% CI: 0.51, 1.14], P = .189, adjusted for age, gender, humeral head size, humeral fixation, bearing surface, glenoid design, and mean surgeon volume [MSV]). There was an increased rate of revision for stTSA and slTSA undertaken with humeral head sizes <44 mm (stTSA <44 mm vs. 44-50 mm, HR = 1.56 [CI: 1.18, 2.08], P = .001; slTSA <44 mm vs. 44-50 mm, HR = 2.08 [CI: 1.32, 3.33], P = .001). MSV as a continuous predictor was not a revision risk to stTSA vs. slTSA, but categorically, a low MSV (<10 stTSA + slTSA cases per annum) was associated with a higher revision rate for stTSA (10-20 cases/yr vs. <10 cases/yr, HR = 0.72 [CI: 0.55, 0.95], P = .019) but was not in slTSA. Revision rates were increased for stTSA with non-crosslinked polyethylene (XLPE) glenoids vs. XPLE after 2 years (HR = 2.20 [CI: 1.57, 3.08], P < .001) but did not significantly differ for slTSA. Metal/XPLE (humeral/glenoid) bearing surface of stTSA rate of revision was not different from each combination of slTSA bearing surface. Instability/dislocation was a revision risk for slTSA vs. stTSA (HR = 1.93 [CI: 1.28, 2.91], P = .001), but from 2017, neither of American Society of Anesthesiologists score, body mass index, and glenoid morphology changed the rate of revision., Conclusions: Revision rates of stTSA and slTSA did not significantly differ and were associated with humeral head size but not patient characteristics. Surgeon inexperience of anatomic shoulder arthroplasty and non-XLPE glenoids were risk factors for stTSA revision but not slTSA. The metal/XLPE stTSA rate of revision was not found to differ significantly from slTSA regardless of polyethylene or humeral head bearing type. Revision for instability/dislocation was more common for slTSA., (Copyright © 2023 Journal of Shoulder and Elbow Surgery Board of Trustees. All rights reserved.)