Impact of Technological and Structural Change on Employment: Prospective Analysis 2020. Background Report

Abstract not availableJRC.J-Institute for Prospective Technological Studies (Seville

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Olecranon With Concomitant Radial Head Fracture: A Case Series of Fifteen Patients

IntroductionSimultaneous olecranon and radial head fractures are rare injuries and due to this factor, the outcome of the selected therapy is not widely studied. The aim of this study is to report and evaluate the functional outcome of the surgical treatment of simultaneous olecranon and radial head fractures.Materials and MethodsThis is a retrospective study of fifteen patients with concomitant olecranon and radial head fractures presenting to our orthopedic department between 2015 and 2020. Olecranon fractures were classified by Mayo classification and radial head fractures by Mason classification and were managed appropriately. Main outcome measures include range of elbow extension-flexion, pronation-supination, Broberg and Morrey rating system score, and quickDASH score.ResultsOur study included 6 females and 9 males with a mean age of 50 (r, 25–73). The mean of follow-up was 31 months (r, 3–51). Olecranon fractures were fixed with tension band with K-Wires or intramedullary compression screw or locking plate. Radial head fractures were fixed with headless compression screws or mini plate or replaced (radial head arthroplasty). Postoperatively, an average 115° extension-flexion arc and 135° pronation-supination arc was noted. The mean Broberg and Morrey rating system score was 78 and the mean quick DASH score was 25, indicating a good result. Two cases of heterotopic ossification were present and no nonunion was noted.ConclusionSurgical management of concomitant olecranon and radial head fractures with appropriate technique can result in the restoration of a functional movement arc and a satisfactory outcome.</jats:sec

Percutaneous repair of the Achilles tendon with one knot offers equivalent results as the same procedure with two knots. A comparative prospective study.

The present prospective comparative study included patients with acute Achilles tendon rupture (ATR) who underwent percutaneous repair with one knot compared to percutaneous repair with two knots. All patients underwent the procedure under local anesthesia. A total of 29 patients underwent percutaneous repair with two knots (Group A), and 33 patients underwent percutaneous repair with one knot (Group B). All patients were treated by a single surgeon between 2019 and 2021 and were followed prospectively for 24 months. Patients' characteristics at baseline were similar between the two groups, except for age [38.0(15.0) vs 32.0(15.0) years, P = 0.028]. The procedure took longer for the two knots technique [19.0(4.0) vs 13.0(3.0) min, P < 0.001]. The Achilles tendon total rupture score was not different between the two techniques (90.7 ± 3.26 vs 90.5 ± 2.18, P = 0.737), as was the elongation of the gastrosoleus-Achilles tendon complex measured by the Achilles tendon resting angle [-1.0(2.0) vs - 1.0(2.0), P < 0.380]. The calf circumference of the injured and non-injured leg did not differ between the groups. Plantarflexion strength of the operated leg was significantly weaker than the non-operated leg in both groups. The European Foot and Ankle Society and patient reported outcome measures score by Piedade et al. scores were not statistically significant different between the two groups. No patient experienced a re-rupture, a venous thrombo-embolism episode, or injury to the sural nerve. The modified technique offered similar objective and subjective outcome measures, in addition to reduced operative time. [Abstract copyright: © The Author(s) 2024. Published by Oxford University Press. All rights reserved. For Permissions, please email: [email protected].

Decentralized Blockchain-Based IoT Data Marketplaces

In present times, the largest amount of data is being controlled in a centralized manner. However, as the data are in essence the fuel of any application and service, there is a need to make the data more findable and accessible. Another problem with the data being centralized is the limited storage as well as the uncertainty of their authenticity. In the Internet of Things (IoT) sector specifically, data are the key to develop the most powerful and reliable applications. For these reasons, there is a rise on works that present decentralized marketplaces for IoT data with many of them exploiting blockchain technology to offer security advantages. The main contribution of this work is to review the existing works on decentralized IoT data marketplaces and discuss important design aspects and options so as to guide (a) the prospective user to select the IoT data marketplace that matches their needs and (b) the potential designer of a new marketplace to make insightful decisions

Decentralized Blockchain-Based IoT Data Marketplaces

In present times, the largest amount of data is being controlled in a centralized manner. However, as the data are in essence the fuel of any application and service, there is a need to make the data more findable and accessible. Another problem with the data being centralized is the limited storage as well as the uncertainty of their authenticity. In the Internet of Things (IoT) sector specifically, data are the key to develop the most powerful and reliable applications. For these reasons, there is a rise on works that present decentralized marketplaces for IoT data with many of them exploiting blockchain technology to offer security advantages. The main contribution of this work is to review the existing works on decentralized IoT data marketplaces and discuss important design aspects and options so as to guide (a) the prospective user to select the IoT data marketplace that matches their needs and (b) the potential designer of a new marketplace to make insightful decisions

Primary augmentation of percutaneous repair with flexor hallucis longus tendon for Achilles tendon ruptures reduces tendon elongation and may improve functional outcome

Purpose: Achilles tendon ruptures (ATR) result in loss of strength and function of the gastrosoleus-Achilles tendon complex, probably because of gradual tendon elongation and calf muscle atrophy, even after surgical repair. Flexor hallucis longus (FHL) augmentation not only reinforces the repair and provides new blood supply to the tendon, but also protects the repair, internally splinting the repaired Achilles tendon, maintaining optimal tension. We prospectively compared the clinical outcomes of patients with acute ATR, managed with either percutaneous repair only or percutaneous repair and FHL augmentation. Methods: Patients with acute ATR undergoing operative management were divided into two groups. Thirty patients underwent percutaneous repair under local anesthesia, and 32 patients underwent percutaneous repair augmented by FHL tendon, harvested through a 3 cm longitudinal posteromedial incision, and transferred to the calcaneus, under epidural anesthesia. All patients were treated by a single surgeon between 2015 and 2019 and were followed prospectively for 24 months. Results: The percutaneous only group was younger than the augmented one (35.4 ± 8.0 vs 40.4 ± 6.6 years, p = 0.01). In the augmented group, 25 patients stayed overnight and only 5 were day cases, whereas in the percutaneous only group 4 patients stayed overnight and 28 of them were day cases (p &lt; 0.001). The duration of the procedure was significantly longer in the augmented group (38.9 ± 5.2 vs 13.2 ± 2.2 min, p &lt; 0.001). At 24 months after repair, the Achilles tendon resting angle (ATRA) was better in the augmented group (-0.5 ± 1.7 vs -4.0 ± 2.7, p &lt; 0.001), as was Achilles tendon rupture score (ATRS) (91.7 ± 2.2 vs 89.9 ± 2.4, p = 0.004). Calf circumference of the injured and the non-injured leg did not differ between the groups, as did the time interval to single toe raise and the time interval to walking in tiptoes. Although plantarflexion strength of the operated leg was significantly weaker than the non-operated leg in both groups, the difference in isometric strength of the operated leg between the groups was not significant at 24 months (435 ± 37.9 vs 436 ± 39.7 N, n.s.). Conclusion: Percutaneous repair and FHL tendon augmentation may have a place in the management of acute Achilles tendon ruptures, reducing tendon elongation and improving functional outcome

Total hip arthroplasty for an intracapsular femoral neck fracture of high-femoral amputee

Femoral neck fractures in transfemoral amputees are not common and management is associated with surgical technique and post-operative rehabilitation challenges. A 61-year-old Caucasian, male, above-knee amputee (following mangled extremity trauma 8 months before) who mobilized with a prosthesis presented to the emergency department with a right femoral neck fracture (Garden III). The patient underwent cementless total hip replacement (THR), using the lateral (Hardinge’s) approach. No additional instrument was used to manipulate the residual femoral stump. The absence of the distal limb required careful preparation of the femoral canal, taking into consideration the position of the lesser trochanter, in order to appropriately align the femoral prosthesis regarding anteversion. Postoperative recovery was uneventful. Six months later, the patient was ambulating using his prothesis and had almost returned to his pre-injury activity status. Satisfactory results can be obtained after THR in trans-femoral amputees.</jats:p