Inter- and intraobserver reliability of the MTM-classification for proximal humeral fractures: A prospective study

<p>Abstract</p> <p>Background</p> <p>A precise modular topographic-morphological (MTM) classification for proximal humeral fractures may address current classification problems. The classification was developed to evaluate whether a very detailed classification exceeding the analysis of fractured parts may be a valuable tool.</p> <p>Methods</p> <p>Three observers classified plain radiographs of 22 fractures using both a simple version (fracture displacement, number of parts) and an extensive version (individual topographic fracture type and morphology) of the MTM classification. Kappa-statistics were used to determine reliability.</p> <p>Results</p> <p>An acceptable reliability was found for the simple version classifying fracture displacement and fractured main parts. Fair interobserver agreement was found for the extensive version with individual topographic fracture type and morphology.</p> <p>Conclusion</p> <p>Although the MTM-classification covers a wide spectrum of fracture types, our results indicate that the precise topographic and morphological description is not delivering reproducible results. Therefore, simplicity in fracture classification may be more useful than extensive approaches, which are not adequately reliable to address current classification problems.</p

Factors Associated with Revision Surgery after Internal Fixation of Hip Fractures

Background: Femoral neck fractures are associated with high rates of revision surgery after management with internal fixation. Using data from the Fixation using Alternative Implants for the Treatment of Hip fractures (FAITH) trial evaluating methods of internal fixation in patients with femoral neck fractures, we investigated associations between baseline and surgical factors and the need for revision surgery to promote healing, relieve pain, treat infection or improve function over 24 months postsurgery. Additionally, we investigated factors associated with (1) hardware removal and (2) implant exchange from cancellous screws (CS) or sliding hip screw (SHS) to total hip arthroplasty, hemiarthroplasty, or another internal fixation device. Methods: We identified 15 potential factors a priori that may be associated with revision surgery, 7 with hardware removal, and 14 with implant exchange. We used multivariable Cox proportional hazards analyses in our investigation. Results: Factors associated with increased risk of revision surgery included: female sex, [hazard ratio (HR) 1.79, 95% confidence interval (CI) 1.25-2.50; P = 0.001], higher body mass index (fo

The future of global river health monitoring

Rivers are the arteries of human civilisation and culture, providing essential goods and services that underpin water and food security, socio-economic development and climate resilience. They also support an extraordinary diversity of biological life. Human appropriation of land and water together with changes in climate have jointly driven rapid declines in river health and biodiversity worldwide, stimulating calls for an Emergency Recovery Plan for freshwater ecosystems. Yet freshwater ecosystems like rivers have been consistently under-represented within global agreements such as the UN Sustainable Development Goals and the UN Convention on Biological Diversity. Even where such agreements acknowledge that river health is important, implementation is hampered by inadequate global-scale indicators and a lack of coherent monitoring efforts. Consequently, there is no reliable basis for tracking global trends in river health, assessing the impacts of international agreements on river ecosystems and guiding global investments in river management to priority issues or regions. We reviewed national and regional approaches for river health monitoring to develop a comprehensive set of scalable indicators that can support “top-down” global surveillance while also facilitating standardised “bottom-up” local monitoring efforts. We evaluate readiness of these indicators for implementation at a global scale, based on their current status and emerging improvements in underlying data sources and methodologies. We chart a road map that identifies data and technical priorities and opportunities to advance global river health monitoring such that an adequate monitoring framework could be in place and implemented by 2030, with the potential for substantial enhancement by 2050. Lastly, we present recommendations for coordinated action and investment by policy makers, research funders and scientists to develop and implement the framework to support conservation and restoration of river health globally.Full Tex

The perception of small and medium sized tourism accommodation providers on the impacts of tour operators' power in eastern Mediterranean

This paper examines the relationship between small and medium sized tourism accommodation enterprises and European tour operators. Leisure "packaged" mass tourism and the Mediterranean basin are the main product and geographical contexts of reference. However, the potential applicability of the outcomes to other similar tourism products and areas is not excluded. Focusing primarily on SMTEs the study draws extensively from secondary research, while it also employs the outcomes of personal interviews of SMTEs' owners/managers on the Greek island of Corfu. The paper portrays the current status of the co-operation between SMTEs and TOs by illustrating the advantages and the problems faced by SMTEs' owners/managers when dealing with TOs. Finally, the study concludes by proposing actions and policies that could be incorporated in SMTEs' strategies in order to strengthen their negotiating position with large tour operating consortiums and ameliorate their evident over-reliance on tourism intermediaries