Post-COVID-19 condition (also known as long COVID) is a new, complex, and poorly understood disorder. A core outcome set (COS) for post-COVID-19 condition in adults has been developed and agreement ...is now required on the most appropriate measurement instruments for these core outcomes. We conducted an international consensus study involving multidisciplinary experts and people with lived experience of long COVID. The study comprised a literature review to identify measurement instruments for the core outcomes, a three-round online modified Delphi process, and an online consensus meeting to generate a core outcome measurement set (COMS). 594 individuals from 58 countries participated. The number of potential instruments for the 12 core outcomes was reduced from 319 to 19. Consensus was reached for inclusion of the modified Medical Research Council Dyspnoea Scale for respiratory outcomes. Measures for two relevant outcomes from a previously published COS for acute COVID-19 were also included: time until death, for survival, and the Recovery Scale for COVID-19, for recovery. Instruments were suggested for consideration for the remaining nine core outcomes: fatigue or exhaustion, pain, post-exertion symptoms, work or occupational and study changes, and cardiovascular, nervous system, cognitive, mental health, and physical outcomes; however, consensus was not achieved for instruments for these outcomes. The recommended COMS and instruments for consideration provide a foundation for the evaluation of post-COVID-19 condition in adults, which should help to optimise clinical care and accelerate research worldwide. Further assessment of this COMS is warranted as new data emerge on existing and novel measurement instruments.
Objectives
The purpose of this agreement was to establish evidence-based consensus statements on imaging of distal radioulnar joint (DRUJ) instability and triangular fibrocartilage complex (TFCC) ...injuries by an expert group using the Delphi technique.
Methods
Nineteen hand surgeons developed a preliminary list of questions on DRUJ instability and TFCC injuries. Radiologists created statements based on the literature and the authors’ clinical experience. Questions and statements were revised during three iterative Delphi rounds. Delphi panelists consisted of twenty-seven musculoskeletal radiologists. The panelists scored their degree of agreement to each statement on an 11-item numeric scale. Scores of “0,” “5,” and “10” reflected complete disagreement, indeterminate agreement, and complete agreement, respectively. Group consensus was defined as a score of “8” or higher for 80% or more of the panelists.
Results
Three of fourteen statements achieved group consensus in the first Delphi round and ten statements achieved group consensus in the second Delphi round. The third and final Delphi round was limited to the one question that did not achieve group consensus in the previous rounds.
Conclusions
Delphi-based agreements suggest that CT with static axial slices in neutral rotation, pronation, and supination is the most useful and accurate imaging technique for the work-up of DRUJ instability. MRI is the most valuable technique in the diagnosis of TFCC lesions. The main indication for MR arthrography and CT arthrography are Palmer 1B foveal lesions of the TFCC.
Clinical relevance statement
MRI is the method of choice for assessing TFCC lesions, with higher accuracy for central than peripheral abnormalities. The main indication for MR arthrography is the evaluation of TFCC foveal insertion lesions and peripheral non-Palmer injuries.
Key points
• Conventional radiography should be the initial imaging technique in the assessment of DRUJ instability. CT with static axial slices in neutral rotation, pronation, and supination is the most accurate method for evaluating DRUJ instability.
• MRI is the most useful technique in diagnosing soft-tissue injuries causing DRUJ instability, especially TFCC lesions.
• The main indications for MR arthrography and CT arthrography are foveal lesions of the TFCC.
Objectives
The purpose of this agreement was to establish evidence-based consensus statements on imaging of scapholunate joint (SLJ) instability by an expert group using the Delphi technique.
Methods
...Nineteen hand surgeons developed a preliminary list of questions on SLJ instability. Radiologists created statements based on the literature and the authors’ clinical experience. Questions and statements were revised during three iterative Delphi rounds. Delphi panellists consisted of twenty-seven musculoskeletal radiologists. The panellists scored their degree of agreement to each statement on an eleven-item numeric scale. Scores of ‘0’, ‘5’ and ‘10’ reflected complete disagreement, indeterminate agreement and complete agreement, respectively. Group consensus was defined as a score of ‘8’ or higher for 80% or more of the panellists.
Results
Ten of fifteen statements achieved group consensus in the second Delphi round. The remaining five statements achieved group consensus in the third Delphi round. It was agreed that dorsopalmar and lateral radiographs should be acquired as routine imaging work-up in patients with suspected SLJ instability. Radiographic stress views and dynamic fluoroscopy allow accurate diagnosis of dynamic SLJ instability. MR arthrography and CT arthrography are accurate for detecting scapholunate interosseous ligament tears and articular cartilage defects. Ultrasonography and MRI can delineate most extrinsic carpal ligaments, although validated scientific evidence on accurate differentiation between partially or completely torn or incompetent ligaments is not available.
Conclusions
Delphi-based agreements suggest that standardized radiographs, radiographic stress views, dynamic fluoroscopy, MR arthrography and CT arthrography are the most useful and accurate imaging techniques for the work-up of SLJ instability.
Key Points
•
Dorsopalmar and lateral wrist radiographs remain the basic imaging modality for routine imaging work-up in patients with suspected scapholunate joint instability
.
•
Radiographic stress views and dynamic fluoroscopy of the wrist allow accurate diagnosis of dynamic scapholunate joint instability
.
•
Wrist MR arthrography and CT arthrography are accurate for determination of scapholunate interosseous ligament tears and cartilage defects
.
African medicinal plant species are increasingly threatened by overexploitation and habitat loss, but little is known about the conservation status and ecology of many medicinal species.
Mondia ...whitei (Apocynaceae, formerly Asclepiadaceae), a medicinal liana found in Sub-Saharan Africa, has been subject to intensive harvesting and habitat loss. We surveyed
M. whitei in Kakamega Forest, the largest of three remnant Kenyan forests known to contain the species. In 174 100
m
2 plots, we quantified the status of
M. whitei and investigated its relationships with land use, disturbance and harvesting. With average adult densities of 101
plants/ha,
M. whitei is not locally rare in Kakamega. However, the absence of flowers and fruits, together with a spatial disconnect between adults and juveniles, suggests that sexual regeneration is patchy or infrequent. Comparing among habitat types, we found that plants were most abundant in regenerating indigenous forest managed by the Forest Department, which permits some extractive uses. Conversely, plants were largest in indigenous forest managed by the Kenya Wildlife Service, which prohibits extractive uses. Most anthropogenic disturbances were not associated with
M. whitei, but plant occurrence and density were higher along paths used by livestock than along other types of paths. Larger individuals appeared to be preferentially harvested, but adult plants were more likely to occur in harvested plots than un-harvested plots. This work emphasizes that restrictions on disturbance and extractive use do not automatically promote medicinal plant conservation. Moreover, harvesting may have important genetic and demographic consequences that are overlooked by studies focused on numerical losses.
The Vicência meteorite, a stone of 1.547 kg, fell on September 21, 2013, at the village Borracha, near the city of Vicência, Pernambuco, Brazil. It was recovered immediately after the fall, and our ...consortium study showed it to be an unshocked (S1) LL3.2 ordinary chondrite. The LL group classification is based on the bulk density (3.13 g cm−3); the chondrule mean apparent diameter (0.9 mm); the bulk oxygen isotopic composition (δ17O = 3.768 ± 0.042‰, δ18O = 5.359 ± 0.042‰, Δ17O = 0.981 ± 0.020‰); the content of metallic Fe,Ni (1.8 vol%); the Co content of kamacite (1.73 wt%); the bulk contents of the siderophile elements Ir and Co versus Au; and the ratios of metallic Fe0/total iron (0.105) versus total Fe/Mg (1.164), and of Ni/Mg (0.057) versus total Fe/Mg. The petrologic type 3.2 classification is indicated by the beautifully developed chondritic texture, the standard deviation (~0.09) versus mean Cr2O3 content (~0.14 wt%) of ferroan olivine, the TL sensitivity and the peak temperature and peak width at half maximum, the cathodoluminescence properties of chondrules, the content of trapped 132Xetr (0.317 × 10−8cm3STP g−1), and the Raman spectra for organic material in the matrix. The cosmic ray exposure age is ~72 Ma, which is at the upper end of the age distribution of LL group chondrites. The meteorite is unusual in that it contains relatively large, up to nearly 100 μm in size, secondary fayalite grains, defined as olivine with Fa>75, large enough to allow in situ measurement of oxygen and Mn‐Cr isotope systematics with SIMS. Its oxygen isotopes plot along a mass‐dependent fractionation line with a slope of ~0.5 and Δ17O of 4.0 ± 0.3‰, and are similar to those of secondary fayalite and magnetite in the unequilibrated chondrites EET 90161, MET 96503, and Ngawi. These data suggest that secondary fayalite in Vicência was in equilibrium with a fluid with a Δ17O of ~4‰, consistent with the composition of the fluid in equilibrium with secondary magnetite and fayalite in other unequilibrated ordinary chondrites. Secondary fayalite and the chondrule olivine phenocrysts in Vicência are not in isotopic equilibrium, consistent with low‐temperature formation of fayalite during aqueous alteration on the LL parent body. That alteration, as dated by the 53Mn‐53Cr chronology age of secondary fayalite, took place 4.0−1.1+1.4 Ma after formation of CV CAIs when anchored to the quenched angrite D'Orbigny.
Total hip joint replacement (THR) is a high volume, effective intervention for hip osteoarthritis (OA). However, indications and determinants of outcome remain unclear. The 'EUROHIP consortium' has ...undertaken a cohort study to investigate these questions. This paper describes the variations in disease severity in this cohort and the relationships between clinical and radiographic severity, and explores some of the determinants of variation.
A minimum of 50 consecutive, consenting patients coming to primary THR for primary hip OA in each of the 20 participating orthopaedic centres entered the study. Pre-operative data included demographics, employment and educational attainment, drug utilisation, and involvement of other joints. Each subject completed the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC - Likert version 3.1). Other data collected at the time of surgery included the prosthesis used and American Society of Anaesthesiologists (ASA) status. Pre-operative radiographs were read by the same three readers for Kellgren and Lawrence (K&L) grading and Osteoarthritis Research Society International (OARSI) atlas features. Regression analyses were carried out.
Data from 1327 subjects has been analysed. The mean age of the group was 65.7 years, and there were more women (53.4%) than men. Most (79%) were ASA status 1 or 2. Reported disease duration was 5 years or less in 69.2%. Disease in other joint sites was common.Radiographs were available in 1051 subjects and the K&L grade was 3 or 4 in 95.8%. There was much more variation in clinical severity (WOMAC score); the mean total WOMAC score was 59.2 (SD 16.1). The radiographic severity showed no correlation with WOMAC scores.Significantly higher WOMAC scores (worse disease) were seen in older people, women, those with obesity, those with worse general health, and those with lower educational attainment.
1. Clinical disease severity varies widely at the time of THR for OA. 2. In advanced hip OA clinical severity shows no correlation with radiographic severity. 3. Simple scores of pain and disability do not reflect the complexity of decision-making about who should have a THR.
This volume brings together key findings of the research project ‘Religious Individualisation in Historical Perspective’ at the Max Weber Centre for Advanced Cultural and Social Studies. Combining a ...wide range of disciplinary approaches, methods and theories, the volume assembles over 50 contributions that explore and compare processes of religious individualisation in Asia, the Mediterranean, and Europe from antiquity to the recent past.
Coronavirus disease 2019 (COVID-19) antiviral response in a pan-tumor immune monitoring (CAPTURE) ( NCT03226886 ) is a prospective cohort study of COVID-19 immunity in patients with cancer. Here we ...evaluated 585 patients following administration of two doses of BNT162b2 or AZD1222 vaccines, administered 12 weeks apart. Seroconversion rates after two doses were 85% and 59% in patients with solid and hematological malignancies, respectively. A lower proportion of patients had detectable titers of neutralizing antibodies (NAbT) against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) variants of concern (VOC) versus wild-type (WT) SARS-CoV-2. Patients with hematological malignancies were more likely to have undetectable NAbT and had lower median NAbT than those with solid cancers against both SARS-CoV-2 WT and VOC. By comparison with individuals without cancer, patients with hematological, but not solid, malignancies had reduced neutralizing antibody (NAb) responses. Seroconversion showed poor concordance with NAbT against VOC. Previous SARS-CoV-2 infection boosted the NAb response including against VOC, and anti-CD20 treatment was associated with undetectable NAbT. Vaccine-induced T cell responses were detected in 80% of patients and were comparable between vaccines or cancer types. Our results have implications for the management of patients with cancer during the ongoing COVID-19 pandemic.
Raising endangered species in captivity for reintroduction necessarily results in animals that lack appropriate skills for coping with problems to be faced in the wild, such as predators. Using ...classical conditioning techniques involving linking fear of a live dog with the image of a fox, we demonstrate an adjusted fear response for two wallaby species (rufous bettongs Aepyprymnus rufescens, quokkas Setonix brachyurus). No differences in response to the fox were found for wild-caught and captive-born bettongs, even though wild-caught subjects were likely to have encountered canids prior to capture. Attempts to condition a fear response by quokkas to an odour were unsuccessful. An attempt to induce fear of the stuffed fox by linking to fear of humans in quokkas was unsuccessful, but quokkas generalised from fear of the dog to fear of the fox, despite a delay of several weeks. Trained dogs offer a valuable and ethically acceptable mechanism for improving the ability of captive-reared (or sequestered) animals to recognise and cope with predators.
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