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INTRODUCTION: Brace treatment is common to address radiological dysplasia in infants with developmental dysplasia of the hip (DDH); however, it is unclear whether bracing provides significant benefit above careful observation by ultrasound. If observation alone is non-inferior to bracing for radiological dysplasia, unnecessary treatment may be avoided. Therefore, the purpose of this study is to determine whether observation is non-inferior to bracing for infants with radiological dysplasia. METHODS AND ANALYSIS: This will be a multicentre, global, randomised, non-inferiority trial performed under the auspices of a global prospective registry for infants and children diagnosed with DDH. Patients will be included if they present with radiological dysplasia (centred hip, alpha angle 43-60°, percent femoral head coverage greater than 35% measured on ultrasound) of a clinically stable hip under 3 months old. Patients will be excluded if they present with clinical hip instability, have received prior treatment or have known/suspected neuromuscular, collagen, chromosomal or lower-extremity congenital abnormalities or syndromic-associated hip abnormalities. Patients will be enrolled and randomised to undergo observation alone or brace treatment with a Pavlik harness for a minimum of 6 weeks. Follow-up visits will occur at 6 weeks, 1 year and 2 years post-enrolment. The primary outcome will be the norm-referenced acetabular index measured on the 2-year radiograph with a 3° non-inferiority margin. A total of 514 patients will be included.The study is anticipated to start in April 2024 and end in September 2028.The primary outcome will be compared between arms with a mixed-effects model with a random intercept for study centre, and a single covariate for the treatment group. If the lower bound of the 95% CI lies within 3° of the mean, we will treat this as evidence for non-inferiority. ETHICS AND DISSEMINATION: Ethics approval has been obtained from the lead sites ethics board (University of British Columbia, Childrens and Womens Research Ethics Board). Ethics approval will be obtained from the local ethics committees or institutional review boards at each institution prior to patient enrolment. It is intended that the results of this study shall be published in peer-reviewed journals and presented at suitable conferences. TRIAL REGISTRATION NUMBER: NCT05869851.

Background: In March 2020, Ontario instituted a lockdown to reduce spread of the SARS-CoV-2 virus. Schools, recreational facilities, and nonessential businesses were closed. Restrictions were eased through 3 distinct stages over a 6-month period (March to September 2020). We aimed to determine the impact of each stage of the COVID-19 public health lockdown on the epidemiology of operative pediatric orthopedic trauma. Methods: A retrospective cohort study was performed comparing emergency department (ED) visits for orthopedic injuries and operatively treated orthopedic injuries at a level 1 pediatric trauma centre during each lockdown stage of the pandemic with caseloads during the same date ranges in 2019 (prepandemic). Further analyses were based on patients' demographic characteristics, injury severity, mechanism of injury, and anatomic location of injury. Results: Compared with the prepandemic period, ED visits decreased by 20% (1356 v. 1698, p < 0.001) and operative cases by 29% (262 v. 371, p < 0.001). There was a significant decrease in the number of operative cases per day in stage 1 of the lockdown (1.3 v. 2.0, p < 0.001) and in stage 2 (1.7 v. 3.0; P < 0.001), but there was no significant difference in stage 3 (2.4 v. 2.2, p = 0.35). A significant reduction in the number of playground injuries was seen in stage 1 (1 v. 62, p < 0.001) and stage 2 (6 v. 35, p < 0.001), and there was an increase in the number of self-propelled transit injuries (31 v. 10, p = 0.002) during stage 1. In stage 3, all patient demographic characteristics and all characteristics of operatively treated injuries resumed their prepandemic distributions. Conclusion: Provincial lockdown measures designed to limit the spread of SARS-CoV-2 significantly altered the volume and demographic characteristics of pediatric orthopedic injuries that required operative management. The findings from this study will serve to inform health system planning for future emergency lockdowns. Contexte : En mars 2020, l'Ontario a décrété des mesures de confinement afin de réduire la propagation du virus SRAS-CoV-2. Les écoles, les installations récréatives, et les commerces non essentiels ont dû fermer. Les restrictions ont été par la suite progressivement assouplies en 3 phases distinctes sur une période de 6 mois (de mars à septembre 2020). Notre objectif était de déterminer les répercussions épidémiologiques de chaque phase du confinement imposé par les autorités de santé publique sur la chirurgie orthopédique pédiatrique et traumatologique. Méthodes : Nous avons réalisé une étude de cohorte rétrospective pour comparer le nombre de consultations aux services d'urgence pour des blessures orthopédiques, traitées ou non en salle d'opération, dans des centres de traumatologie pédiatrique de niveau 1 pendant chaque phase de confinement avec le nombre de consultations pendant les mêmes périodes de l'année en 2019 (prépandémie). Nous avons effectué des analyses complémentaires en fonction des caractéristiques démographiques de la patientèle, ainsi que de la gravité, du mécanisme et de la localisation des blessures. Résultats : Comparativement à la période prépandémique, la fréquentation des services d'urgence a diminué de 20% (1356 c. 1698, p < 0,001) et le nombre d'interventions chirurgicales, de 29% (262 c. 371, p < 0,001). Nous avons constaté une baisse significative du nombre d'interventions chirurgicales lors de la phase 1 du confinement (1,3 c. 2,0, p < 0,001), ainsi que lors de la phase 2 (1,7 c. 3,0, p < 0,001), mais aucune différence significative n'a été observée lors de la phase 3 (2,4 c. 2,2, p = 0,35). Par ailleurs, nous avons constaté une baisse significative du nombre de blessures survenues sur des terrains de jeux durant la phase 1 (1 c. 62, p < 0,001) et la phase 2 (6 c. 35, p < 0,001), alors que le nombre de blessures occasionnées par des véhicules automoteurs a augmenté (31 c. 10, p = 0,002) lors de la phase 1. Enfin, lors de la phase 3, tous les paramètres démographiques de la patientèle et toutes les caractéristiques des blessures traitées en salle d'opération sont revenus à leurs valeurs prépandémiques. Conclusion : Les mesures de confinement prises au niveau provincial pour limiter la propagation du virus SRAS-CoV-2 ont significativement modifié le volume et les caractéristiques démographiques des blessures orthopédiques pédiatriques nécessitant une prise en charge chirurgicale. Les résultats de cette étude serviront à améliorer la planification du système de santé en cas de nouveau confinement d'urgence., The COVID-19 pandemic has had an unprecedented impact on health care systems. At its height, governments worldwide implemented various public healdi measures to limit exposure to the virus and to [...]

Traditional practical work for higher education in STEM subjects is under pressure from rising student numbers and a desired increase in active learning. Investing in more buildings and staff is financially challenging, while stretching existing resources affects outcomes, health, and participation. A more pragmatic approach is to embrace a less instrumentalist view of practical work in physical spaces and instead adopt a critical post-humanist approach which mixes both humanity and technology to achieve a sum greater than the parts, not bound by the limits of either. We share the experiences of leading UK exponents of non-traditional laboratories in the four main categories of simulation, virtual laboratories, real-asynchronous, and real-synchronous activities, as well as experts in scaling digital education initiatives for university-wide adoption. We foreshadow opportunities, challenges and potential solutions to increasing the opportunity for active learning by students studying at traditional campuses, via the complementary addition of non-traditional practical work.

Virtual Learning Environments (VLEs) are becoming commonplace in Higher Education. Amongst the latest VLE developments is the design and use of Virtual Microscopes (VMs) that allow for viewing and manipulation of online images by multiple students. Although students are found to be generally satisfied with the use of VMs, it is yet not known what teaching and learning conditions better support their use and lead to enhanced learning outcomes. The aim of this paper is to compare the usage patterns and perceptions of two different cohorts of undergraduate students that made use of the VM in blended and online only learning conditions respectively, and draw conclusions about the pedagogy that better supports teaching and learning with VMs. Data collected from a survey with 139 students and 11 semi-structured interviews revealed that blended learning better caters for students' engagement and satisfaction due to the systematic use of the VM in course design, its complementary use with a physical microscope, and the ongoing provision of tutors' support and guidance. Equally good perceived learning gains were reported by both blended and online only students. Implications for the design of learning environments around virtual microscopy are discussed.

Screen-based microscopes allow for a shared visualisation and task-directed conversations that offer significant pedagogic advantages for the science disciplines involving observation of natural samples such as the geosciences and biosciences, and particularly for distance education in these disciplines. The role and development of a virtual microscope used in the undergraduate teaching of geoscience at the Open University is discussed and then related to current developments in the collaborative web-based technologies and mobile computing. (Contains 3 figures and 1 table.)