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A response by M. Basu, B. Wise, and J. Duckett to a letter to the editor about their article "A qualitative study of women's preferences for treatment of pelvic floor disorders" in the 2011 issue is presented.

Animal urine deposited on pastoral soils during grazing is recognised as a dominant source of nitrous oxide (N2O) emissions. The nitrification inhibitor, dicyandiamide (DCD), is a potential mitigation technology to control N2O emissions from urine patches on grazed pastures. One delivery option is to include DCD in animal feed so that the DCD is targeted directly in the urine patch when excreted in the animal urine. The hypothesis tested in the present study was that DCD in urine, excreted by cows that were orally administered with DCD, would have the same effect as DCD added to urine after the urine is excreted. The study also aimed to determine the most effective DCD rate for reducing N2O emissions. Fresh dairy cow urine (700 kg N per ha) was applied to a free-draining silt loam pastoral soil in Waikato, New Zealand, in May (late autumn) or July (winter) of 2014, and was mixed with DCD at rates of 0, 10, 30 and 60 kg/ha. In late autumn, there was an equivalent treatment of urine (containing 60 kg DCD per ha) from DCD-treated cows. A static chamber technique was used to determine gaseous N2O emissions. An annual emission factor (EF3; the percentage of applied urine N lost as N2O-N) of 0.23% or 0.21% was found following late-autumn or winter applications of urine without DCD. Late-autumn application of urine containing DCD from oral administration to cows had the same significant reduction effect on N2O emissions as did DCD that was mixed with urine after excretion, at the equivalent DCD application rate of 60 kg/ha. Application of urine with DCD mixed with the urine after excretion at varying DCD rates showed a significant (P < 0.05) linear decrease in both N2O emissions and EF3 values. [ABSTRACT FROM AUTHOR]

The chemical environment was measured in vertical and horizontal profiles of cores taken from intertidal sediments that are extensively burrowed by the mud crab Helice crassa. The crab burrows folded the thin (2-5 mm) oxic layer into the sediment, and the burrows appeared tohave a strong influence on the concentrations of acid volatile sulfide (AVS), acid-extractable FeII (probably FeCO3and FeS), FeIII (probably predominantly hydrous ferric oxide FeOOH), and MnII, III, IV and a modest effect on FeS2 but no effect on total organic carbon, total organic nitrogen, or acid-extractable zinc concentrations. The oxic layer was thinner in the burrows than on the sediment surface and showed some minordifferences in solid-state chemistry, with higher FeOOH and lower FeS2 concentrations in the burrow walls. Acid volatile sulfide, FeCO3, and FeS2 were found in the oxic layers, presumably because of deposits from crab excavations of deeper anoxic sediments. The chemistry of the bioturbated profile was highly variable, not only because of existing burrows but also because of infilled abandoned burrows. The colors of the sediment profile were strongly related to the concentrations of FeII, AVS, FeIII, Mn, and FeS2. The implications of the observed sediment chemistry to the fate and bioavailability of contaminants is discussed. [ABSTRACT FROM AUTHOR]

Here, we report a study which was designed to examine the effect of a nitrification inhibitor dicyandiamide (DCD) on NO emissions from pasture urine patches. The aspects of DCD use that were studied were delivery method, application rate, and timing of dairy cow urine deposition. Dairy cow urine (700 kg N ha) was applied to pasture on a free draining Otorohanga silt loam soil in New Zealand in the autumn and winter of 2013 with DCD applied at different rates (0, 10, 30, and 60 kg ha). In the autumn, DCD was delivered to the soil either by mixing DCD with the urine collected from dairy cows or by using urine from cows that had ingested DCD while being kept in a stall. In the winter, only treatments with DCD mixed in urine were used. Total NO emissions from urine applied in the autumn or the winter were 1.66 or 1.79 kg NO-N ha year, respectively. This resulted in an annual emission factor (EF, as a percentage of applied urine N lost as NO-N) of 0.21 and 0.20 %, respectively. The EF was reduced equally with either DCD delivery method with the reductions increasing with increasing DCD rate. This indicates that DCD in urine, excreted by cows that are provided DCD-amended feed, can effectively reduce NO emissions and that a higher DCD rate will be more effective. Further work is required to ensure that DCD applied using this innovative technique is also effective using different feed and animal types under a range of environmental conditions. [ABSTRACT FROM AUTHOR]

Information on shore-based recreational fishing is essential for the sustainable management of nearshore fish stocks. However, obtaining estimates of catch and effort from such fishing activity can be complex and expensive due to the large spatial scales over which surveys are typically conducted and the fine-scale temporal resolution that is desired. Complementary surveys are one option for improving the accuracy of estimates. A pilot study was conducted in Perth, Western Australia, from April to June 2010 to test an expanded aerial-roving survey design that incorporated remotely operated cameras. Cameras recorded the distribution of shore-based fishing activity across a 24-h day, highlighting an afternoon peak as well as some nighttime activity, which is rarely captured in existing survey designs. This information was combined with instantaneous counts of shore fishers from aerial surveys and trip length data that were obtained from 1,194 incomplete trip interviews conducted during roving creel surveys; the resulting estimate of fishing effort was 213,460 angler-hours (SE = 18,141; relative SE [RSE] = 8%). Catch rates, which were calculated from roving creel survey data on the numbers of retained fish, were combined with fishing effort to estimate a total retained catch of 355,801 fish (SE = 41,446; RSE = 12%). The Australian herring Arripis georgianus was the dominant species, with a retained catch of 229,779 fish (SE = 39,007; RSE = 17%). In comparison with other on-site techniques, the incorporation of cameras into an aerial-roving survey design provides a generic, cost-effective method for measuring the distribution of shore-based fishing activity across a 24-h day. Our findings improve the understanding of the exploitation of nearshore fish stocks along the Perth coast. Our method has broad application to many other recreational fisheries around the world, especially where nighttime fishing is popular. [ABSTRACT FROM AUTHOR]

Background: Physicians and other health care personnel rely on the peer-reviewed biomedical literature as a key source for making clinical decisions. Thus, ensuring that the nonclinical and clinical findings published in biomedical journals are reported accurately and clearly, without undue influence from commercial interests, is essential. Accordingly, beginning in the mid-1990s and continuing to the present, various organizations, including the International Committee of Medical Journal Editors, the American Medical Association, the Council of Science Editors, the American Medical Writers Association, and the International Society for Medical Publication Professionals, have published guidelines to strengthen and uphold ethical standards in biomedical communications.Scope: A task force of staff members from the AXIS group of companies reviewed these and other guidelines to assess the need for a good publication practices (GPP) document specific to medical communications agencies. As this review demonstrated an unmet need, the task force was charged with developing GPP guidelines for the AXIS group of agencies in the United States.Findings: Although such guidelines have been previously published on behalf of medical journal editors and publishers, medical writers, academic centers, and pharmaceutical companies, there has been no prior publication in the peer-reviewed literature of good publication practices for medical communications agencies, which face unique challenges in negotiating a balance among authors, sponsoring companies, and biomedical publishers.Conclusion: This article presents and discusses these GPP guidelines. To our knowledge, this is the first publication of guidelines developed from the perspective of a medical communications agency. [ABSTRACT FROM AUTHOR]

Although recreational fishing at night is a popular activity, crepuscular and nocturnal fishing effort and catches are often unaccounted for in fisheries assessments. Here, we present a method for estimating 24-h shore-based recreational fishing effort involving the analysis of data from dual-lens thermographic cameras. Cameras were installed at three sites along the foreshore in Peel-Harvey Estuary, a Ramsar Wetland in Western Australia. Stratified random sampling was used to select days for image analysis between March 2015 and February 2016 and examination of images enabled fishing effort to be calculated for the 12-month period. Crepuscular recreational fishing effort at the three sites ranged between 4.5% and 11.3% and nocturnal recreational fishing effort ranged between 6.1% and 26.9% of total recreational fishing effort. Crepuscular and nocturnal recreational fishing were more prevalent between November and March and occurred on both weekdays and weekend days. The majority of recreational fishers identified from the day-time images (96.5%) were targeting blue swimmer crabs (Portunus armatus) using scoop nets. Multiple lines of evidence suggest that most crepuscular and nocturnal activity involved the same method of fishing. The results demonstrate that restricting onsite recreational fishing surveys to daylight hours can lead to large underestimates of total fishing effort and total recreational catches within a fishery. Our method can easily be applied to other fisheries to justify the inclusion of night-time onsite sampling and to design cost-effective sampling strategies. [ABSTRACT FROM AUTHOR]

Nitrous oxide (N2O) emissions (EN2O) from drained peat soils used for pastoral agriculture have not been measured throughout the year in New Zealand. In response to this research gap, EN2Owas measured fortnightly for 1 year in the Waikato region in a plot that was not grazed or nitrogen (N) fertilised. The time series was variable, the frequency distribution skewed and the fortnightly means correlated. To account for these factors, the data were logetransformed and an order 2 autoregressive model used to estimate a mean EN2Oof 4.3 g N ha−1 d−1and 95% confidence limits of 0.6–29.1 g N ha−1 d−1. There was a statistically significant, inverse relationship between EN2Oand the depth to groundwater. In winter, when rainfall totalled 393 mm, EN2Oand soil N content were significantly greater under a rain shelter designed to minimise N loss by leaching, than in an uncovered plot. [ABSTRACT FROM AUTHOR]

Catch sharing among fishing sectors requires credible data for decision-making, allocation and management. Integrated Fisheries Management in Western Australia formally allocates allowable catch for Western Rock Lobster ( WRL) ( Panulirus cygnus) with 95% commercial and 5% recreational; Roe's abalone ( Haliotis roei) with 36 t commercial and 40 t recreational; and West Coast Demersal Scalefish ( WCDS) with 64% commercial and 36% recreational. While commercial catch is obtained from statutory returns, estimates of recreational catches from surveys depend upon spatial and temporal scales of the resource and fishing activity. WRL is a single-species, licensed recreational fishery operating across large spatial and temporal scales. Mail surveys supplemented with occasional phone-recall surveys provide cost-effective monitoring. Roe's abalone is a single-species, licensed recreational fishery operating over restricted spatial and temporal scales appropriate for aerial-access surveys. The WCDS recreational fishery targets multiple species across large spatial and temporal scales. The introduction of charter logbooks and a Recreational Fishing from Boat Licence has provided the basis for monitoring charter and private boat-based recreational fishing. Monitoring allocations is ongoing, with routine surveys required to provide catch estimates with a known confidence. This study highlights the application and importance of surveys in providing timely and accurate data for formal catch sharing. [ABSTRACT FROM AUTHOR]

Sensitivity analyses were incorporated in a Phase III study of caspofungin vs. liposomal amphotericin B as empirical antifungal therapy for febrile neutropenic patients to determine the impact of varying definitions of fever resolution on response rates. Methods. The primary analysis used a 5-part composite endpoint: resolution of any baseline invasive fungal infection, no breakthrough invasive fungal infection, survival, no premature discontinuation of study drug, and fever resolution for 48 h during the period of neutropenia. Pre-specified analyses used 3 other definitions for fever resolution: afebrile for 24 h during the period of neutropenia, afebrile at 7 days post therapy, and eliminating fever resolution altogether from the composite endpoint. Patients were stratified on entry by use of antifungal prophylaxis and risk of infection. Allogeneic hematopoietic stem cell transplants or relapsed acute leukemia defined high-risk patients. Results. In the primary analysis, 41% of patients in each treatment group met the fever-resolution criteria. Low-risk patients had shorter durations of neutropenia but failed fever-resolution criteria more often than high-risk patients. In each exploratory analysis, response rates increased in both treatment groups compared to the primary analysis, particularly in low-risk patients. Conclusions. Response rates for the primary composite endpoint for both treatment groups in this study were driven by low rates of fever resolution. Requiring fever resolution during neutropenia in a composite endpoint can mask more clinically relevant outcomes. [ABSTRACT FROM AUTHOR]

Angiomyofibroblastoma (AMF) is a recently described, rare, benign soft tissue vulvovaginal tumour that occurs mainly but not exclusively in the vulval region of pre-menopausal women (Fletcher et al. in Am J Surg Pathl 16:373; 1992). The first case was diagnosed in 1992. We report a case of a post-menopausal woman with a 2-month history of a rapidly growing painless vaginal tumour and thus drawing the attention of gynaecologist as well as general practitioners to the fact that this rare phenomenon can occur outside the vulva. [ABSTRACT FROM AUTHOR]

A fracture liaison service is a systems-level multidisciplinary approach designed to reduce subsequent fracture risk in patients who recently sustained fragility fractures. It is estimated that one in three women and one in five men over the age of 50 years old have osteoporosis. Nonetheless, only 9 to 20% of patients who sustain an initial fragility fracture eventually receive any osteoporosis treatment. With the aim of preventing subsequent fractures, a fracture liaison service (FLS) works through identifying patients presenting with fragility fractures to the hospital and providing them with easier access to osteoporosis care through referrals for bone health and fracture risk assessment and recommendation or initiation of osteoporosis treatment. Currently, there are four major types of FLS models ranging from services that only identify at-risk patients and inform and educate the patient but take no further part in communicating their findings to other stakeholders in patients' care, to services that identify, investigate, and initiate treatment at the other end of the spectrum. In this article, we review the benefits, challenges, and outcomes of FLS in the American healthcare system with further exploration of the roles each member of the multidisciplinary team can play in improving patients' bone health., (© 2024. This is a U.S. Government work and not under copyright protection in the US; foreign copyright protection may apply.)

Background: The purpose of this study was to externally validate a predictive score for fracture-related infections, establishing generalizability for absolute and relative risk of infection in the setting of orthopedic fracture surgery., Materials and Methods: This was a retrospective, case-control study performed at a level I academic trauma center that included 147 patients with fracture-related infection in the study group and 300 control patients. We analyzed the same 8 independent predictors of fracture-related infection cited by a previous study. We then used the area under the receiver operating characteristics curve (AUC) to compare the derivation and validation cohorts. The validation and derivation cohorts were then compared by grouping patients into 4 strata of Wise score groups. This allowed for comparison of AUC and risk of fracture-related infection in our institution with those in the previously studied institution., Results: The resulting data yielded an AUC (0.74) nearly identical to that of the previously studied institution. It was also found that the relative risk of infection correlated with the Wise score in the same way the initial model did with the absolute risks being similar., Conclusion: The previous predictive model was externally validated and shown to be generalizable to a different patient population. The relative risk of a fracture-related infection can be determined using this scoring model preoperatively with the goal of aiding in patient counseling and surgical decision-making, giving a quantitative value to patient risk factors. [ Orthopedics . 2024;47(5):e268-e272.].

Background: Intubated preterm infants 32 6 / 7 weeks or less of gestation in a mid-Atlantic level IV neonatal intensive care unit (NICU) faced a high number of ventilator days. Based on 6 weeks of electronic health record (EHR) chart audits of extubations in this NICU in 2021, 44% of preterm infants 32 6 / 7 weeks or less of gestation were intubated for more than 28 days, with an average of 23 days on a ventilator. This NICU lacked a standardized extubation guideline providing criteria to drive extubation eligibility., Purpose: The purpose of this quality improvement (QI) project was to implement and evaluate the effectiveness of an extubation readiness guideline in preterm infants 32 6 / 7 weeks or less of gestation in a mid-Atlantic level IV NICU., Methods: This project occurred over a 17-week period in 2021. Implementation included a multidisciplinary committee formation, identification of champions, NICU staff education, completion of a guideline checklist by bedside nursing (for eligible patients), clinician reminders, and chart audits for collection of pre-/postimplementation data. Staff education completion, guideline use and compliance, demographic patient data, ventilator days, time to first extubation, and need for reintubation were tracked., Results: Postimplementation data indicated decreased need for intubation for more than 28 days, ventilator days, and days to first extubation attempt., Implications for Practice and Research: Results suggested that implementation of the evidence-based guideline was effective in decreasing average total ventilator days for preterm infants 32 6 / 7 weeks or less of gestation., Competing Interests: The authors declare no conflicts of interest., (Copyright © 2024 by The National Association of Neonatal Nurses.)

The primary care (PC) physician workforce has consistently been projected as requiring additional numbers to meet the needs of the U.S. The Health Resources and Service Administration (HRSA) has reported the PC nurse practitioner (NP) workforce to be 90,000 NPs more than required to meet the PC needs of the U.S. With both clinician types contributing to the PC workforce in the country, it is difficult to understand such an oversupply of NPs with continued deficit in PC physicians. The purpose of this study was to investigate results and methods used for HRSAs current PC workforce projections and compare those with the same used for Bureau of Labor Statistics (BLS) and American Association of Medical Colleges (AAMC) projections. Methods included a review of technical documents, dashboards, and published reports. Interviews with subject matter experts were also completed. Projections were found to differ significantly, as did data and assumptions. Two of the three projections modeled physicians as the sole provider of PC. An integrated model gives the most comprehensive and accurate picture of PC workforce needs. The utilization of NPs as PC providers has been demonstrated to be safe and effective, with the potential to alleviate predicted shortages, improve patient care outcomes, reduce cost, and address PC inequities. Implications include improving workforce data, creating projections that mirror clinical integration in PC, adjusting workforce preparation funding, incentivizing interprofessional collaboration in research, addressing barriers to practice among non-physician providers, and leveraging growth in the NP workforce., Competing Interests: Declaration of Conflicting InterestsThe authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Introduction: According to a 2009 study published in the Journal of Clinical Oncology, 79% of women (N = 222) diagnosed with breast cancer reported that they identified their cancers through breast self-exam (BSE). However, the U.S. Preventative Services Task Force does not require clinicians to teach women how to perform BSE., Methods: To address this grave challenge, our team at the Technology Enabled Clinical Improvement (TECI) Center has developed a mobile, sensor-enabled haptic training system to teach women proper BSE technique. To validate the efficacy of the training system, our team deployed a data collection at the 2019 Breast Cancer and African Americans (BCAA) event where survey, sensor, and anecdotal data were collected from 61 participants. The custom-built breast model used in this study had a single, hard mass embedded in it., Results: Participants at the BCAA event were able to successfully identify the mass 65% of the time and used an average force of 7.2 N. When looking at participants' confidence in their abilities to perform BSE, only 10% of respondents answered "very confident" pre-training whereas post-training, the reporting for "very confident" jumped to 66% (p < 0.01)., Conclusion: By comparison, our previous work revealed that practitioners who use less than 10 N of force are 70% more likely to miss a lesion. The integration of sensors into the BSE haptic training system allowed for objective, evidence-based assessment of hands-on skill. In addition to teaching women proper BSE technique, this training empowered women to be informed advocates in their breast health journey. Future community-based training/feedback sessions will allow for continuous advancement of the training system., Competing Interests: Declaration of competing interest The authors have no conflicts of interest to disclose., (Copyright © 2023 Elsevier Inc. All rights reserved.)

Purpose: Surgical trauma may confer additional infectious risk after operative fixation for high energy tibial plateau fractures. This study aims to determine the impact of plate number and location on infection rates after these injuries., Methods: This retrospective cohort study completed at two level one trauma centers included patients who underwent staged fixation for a tibial plateau fracture between 2015 and 2019. Plate number and location (lateral, medial, posteromedial, and anterior quadrants) used in the definitive fixation construct were collected from post-operative radiographs. Deep infection rate was primary the outcome., Results: A total of 244 patients met inclusion criteria. The overall infection rate was 13.9% (34/244). Infection rates increased with each additional quadrant utilized (8.0% one quadrant, 13.0% two quadrants, 27.3% three quadrants, 100% four quadrants; p < 0.001), independent of plate number, fracture severity, operative time, number of incisions, external fixator pin and plate construct overlap, and days in the external fixator on multivariate analysis., Conclusions: Infection risk increases with each quadrant utilized in the fixation of high energy tibial plateau fractures. Providers should attempt to limit the dissection of soft tissue for hardware placement in the fixation of these injuries to limit infection risk., Level of Evidence: Level III, retrospective therapeutic study., (© 2022. The Author(s), under exclusive licence to Springer-Verlag France SAS, part of Springer Nature.)

Costs of healthcare in the US continue to rise at rates that are unsustainable. Prior studies, most of which come from non-surgical specialties, indicate that a variety of strategies to teach this material are utilized but without consensus on best practices. No studies exist regarding the teaching of cost-effective care in orthopaedic residency training programs. The goal of this study was to assess the landscape in this area from the perspective of program leadership., Methods: A survey was developed that was sent to orthopaedic residency program leadership via email through their interaction with the COERG. Additional programs were included to enhance diversity of responding programs. The survey, based on those published from other areas of medicine, included questions about the experiences of the respondents in learning about cost-effective care, as well as how faculty and residents learned about this topic., Results: Seventy one percent (30) of respondents noted that their faculty did not receive formal training in cost-effective care, and education in this area was likely to come from the department, especially review of practice data (12, 44%). Only 19% (8) of respondents agreed with the statement that "the majority of teaching faculty in our program consistently model cost-effective healthcare to residents". Few of the programs (10, 24%) had formal curricula for residents regarding cost-effective care, and the primary mode of education in cost-effective care was through informal discussions with faculty (17, 43%). Few residents (3, 13%) were able to easily find the costs of tests or procedures., Discussion: There is not consistent education in cost-effective care for orthopaedic surgery program leadership, faculty, or trainees. The results of this survey demonstrate a need for discussion of best practices, including increasing access to cost data at a local level, and engaging with the AOA, CORD, and the American Academy of Orthopaedic Surgeons more broadly in the development of standard education modules for faculty and residents, to improve the current and future delivery of cost-effective musculoskeletal care., Competing Interests: Disclosure: The Disclosure of Potential Conflicts of Interest forms are provided with the online version of the article (http://links.lww.com/JBJSOA/A515)., (Copyright © 2023 The Authors. Published by The Journal of Bone and Joint Surgery, Incorporated. All rights reserved.)

Introduction Postoperative stiffness is a common complication after high-energy tibial plateau fractures. Investigation into reported surgical techniques for the prevention of postoperative stiffness is limited. The purpose of this study was to compare the rates of postoperative stiffness after second-stage definitive surgery for high-energy tibial plateau fractures between groups of patients who had the external fixator prepped into the surgical field and those who did not. Methods Two hundred forty-four patients met the inclusion criteria between the two academic Level I trauma centers, representing the retrospective observational cohort. Patients were separated based on prepping of the external fixator into the surgical field during second-stage definitive open reduction and internal fixation. One hundred sixty-two patients were in the prepped group and 82 were in the non-prepped group. Post-operative stiffness was determined by the need to return to the operating room for subsequent procedures. Results At the final follow-up (mean = 14.6 months), patients in the non-prepped group had an increased rate of stiffness post-operatively (18.3% non-prepped versus 6.8% prepped; p = 0.006). No other investigated variables were associated with increased post-operative stiffness, including the number of days spent in the fixator and operative time. The relative risk for post-operative stiffness associated with complete fixator removal was 2.54 (95% CI 1.26-4.41; p = 0.008 on binary logistic regression; absolute risk reduction 11.5%). Conclusion At the final follow-up, maintenance of an intraoperative external fixator as a reduction aid was associated with a clinically significant decrease in post-operative stiffness after definitive management of high-energy tibial plateau fractures, when compared with complete removal prior to prepping., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Speybroeck et al.)

Large carnivores are recovering in many landscapes where the human footprint is simultaneously growing. When carnivores encounter humans, the way they behave often changes, which may subsequently influence how they affect their prey. However, little research investigates the behavioural mechanisms underpinning carnivore response to humans. As a result, it is not clear how predator-prey interactions and their associated ecosystem processes will play out in the human-dominated areas into which carnivore populations are increasingly expanding. We hypothesized that humans would reduce predation risk for prey by disturbing carnivores or threatening their survival. Alternatively, or additionally, we hypothesized that humans would increase predation risk by providing forage resources that congregate herbivorous prey in predictable places and times. Using grey wolves Canis lupus in Jackson Hole, Wyoming, USA as a study species, we investigated 170 kill sites across a spectrum of human influences ranging from heavily restricted human activities on protected federal lands to largely unregulated activities on private lands. Then, we used conditional logistic regression to quantify how the probability of predation changed across varied types and amounts of human influences, while controlling for environmental characteristics and prey availability. Wolves primarily made kills in environmental terrain traps and where prey availability was high, but predation risk was significantly better explained with the inclusion of human influences than by environmental characteristics alone. Different human influences had different, and even converse, effects on the risk of wolf predation. For example, where prey were readily available, wolves preferentially killed animals far from motorized roads but close to unpaved trails. However, wolves responded less strongly to humans, if at all, where prey were scarce, suggesting they prioritized acquiring prey over avoiding human interactions. Overall, our work reveals that the effects of large carnivores on prey populations can vary considerably among different types of human influences, yet carnivores may not appreciably alter predatory behaviour in response to humans if prey are difficult to obtain. These results shed new light on the drivers of large carnivore behaviour in anthropogenic areas while improving understanding of predator-prey dynamics in and around the wildland-urban interface., (© 2023 The Authors. Journal of Animal Ecology published by John Wiley & Sons Ltd on behalf of British Ecological Society.)

Introduction: Video-based review of surgical procedures has proven to be useful in training by enabling efficiency in the qualitative assessment of surgical skill and intraoperative decision-making. Current video segmentation protocols focus largely on procedural steps. Although some operations are more complex than others, many of the steps in any given procedure involve an intricate choreography of basic maneuvers such as suturing, knot tying, and cutting. The use of these maneuvers at certain procedural steps can convey information that aids in the assessment of the complexity of the procedure, surgical preference, and skill. Our study aims to develop and evaluate an algorithm to identify these maneuvers., Methods: A standard deep learning architecture was used to differentiate between suture throws, knot ties, and suture cutting on a data set comprised of videos from practicing clinicians (N = 52) who participated in a simulated enterotomy repair. Perception of the added value to traditional artificial intelligence segmentation was explored by qualitatively examining the utility of identifying maneuvers in a subset of steps for an open colon resection., Results: An accuracy of 84% was reached in differentiating maneuvers. The precision in detecting the basic maneuvers was 87.9%, 60%, and 90.9% for suture throws, knot ties, and suture cutting, respectively. The qualitative concept mapping confirmed realistic scenarios that could benefit from basic maneuver identification., Conclusions: Basic maneuvers can indicate error management activity or safety measures and allow for the assessment of skill. Our deep learning algorithm identified basic maneuvers with reasonable accuracy. Such models can aid in artificial intelligence-assisted video review by providing additional information that can complement traditional video segmentation protocols., (Copyright © 2022 Elsevier Inc. All rights reserved.)

Introduction: Artificial Intelligence (AI) has shown promise in facilitating surgical video review through automatic recognition of surgical activities/events. There are few public video data sources that demonstrate critical yet rare events which are insufficient to train AI for reliable video event recognition. We suggest that a generative AI algorithm can create artificial massive bleeding images for minimally invasive lobectomy that can be used to augment the current lack of data in this field., Materials and Methods: A generative adversarial network (GAN) algorithm was used (CycleGAN) to generate artificial massive bleeding event images. To train CycleGAN, six videos of minimally invasive lobectomies were utilized from which 1819 frames of nonbleeding instances and 3178 frames of massive bleeding instances were used., Results: The performance of the CycleGAN algorithm was tested on a new video that was not used during the training process. The trained CycleGAN was able to alter the laparoscopic lobectomy images according to their corresponding massive bleeding images, where the contents of the original images were preserved (e.g., location of tools in the scene) and the style of each image is changed to massive bleeding (i.e., blood automatically added to appropriate locations on the images)., Conclusions: The result could suggest a promising approach to supplement the lack of data for the rare massive bleeding event that can occur during minimally invasive lobectomy. Future work could be dedicated to developing AI algorithms to identify surgical strategies and actions that potentially lead to massive bleeding and warn surgeons prior to this event occurrence., (Copyright © 2022 Elsevier Inc. All rights reserved.)

Background: Tibial plateau fractures with an ipsilateral compartment syndrome are a clinical challenge with limited guidance regarding the best time to perform open reduction and internal fixation (ORIF) relative to fasciotomy wound closure. This study aimed to determine if the risk of fracture-related infection (FRI) differs based on the timing of tibial plateau ORIF relative to closure of ipsilateral fasciotomy wounds., Methods: A retrospective cohort study identified patients with tibial plateau fractures and an ipsilateral compartment syndrome treated with 4-compartment fasciotomy at 22 US trauma centers from 2009 to 2019. The primary outcome measure was FRI requiring operative debridement after ORIF. The ORIF timing relative to fasciotomy closure was categorized as ORIF before, at the same time as, or after fasciotomy closure. Bayesian hierarchical regression models with a neutral prior were used to determine the association between timing of ORIF and infection. The posterior probability of treatment benefit for ORIF was also determined for the three timings of ORIF relative to fasciotomy closure., Results: Of the 729 patients who underwent ORIF of their tibial plateau fracture, 143 (19.6%) subsequently developed a FRI requiring operative treatment. Patients sustaining infections were: 21.0% of those with ORIF before (43 of 205), 15.9% at the same time as (37 of 232), and 21.6% after fasciotomy wound closure (63 of 292). ORIF at the same time as fasciotomy closure demonstrated a 91% probability of being superior to before closure (RR, 0.75; 95% CrI, 0.38 to 1.10). ORIF after fasciotomy closure had a lower likelihood (45%) of a superior outcome than before closure (RR, 1.02; 95% CrI; 0.64 to 1.39)., Conclusion: Data from this multicenter cohort confirms previous reports of a high FRI risk in patients with a tibial plateau fracture and ipsilateral compartment syndrome. Our results suggest that ORIF at the time of fasciotomy closure has the highest probability of treatment benefit, but that infection was common with all three timings of ORIF in this difficult clinical situation., Competing Interests: Declaration of Competing Interests None., (Copyright © 2022. Published by Elsevier Ltd.)

Objectives: To compare infection rates after second-stage definitive surgery for high-energy tibial plateau fractures between groups of patients who had the external fixator prepped into the surgical field and those who did not., Design: Retrospective cohort study., Setting: Two academic Level 1 trauma centers., Patients/participants: Two hundred forty-four patients met inclusion and exclusion criteria between the 2 institutions., Intervention: Prepping of the external fixator into the surgical field during second-stage definitive open reduction and internal fixation. 162 patients were in the prepped group, and 82 patients were in the nonprepped group., Main Outcome Measurements: The primary outcome was the rate of deep infection after definitive fixation. Secondary outcome was operative time., Results: There were no significant differences in infection rates between prepped (11.7%) and nonprepped (18.3%) groups ( P = 0.162). Patients in the prepped groups had significantly decreased operative time (168.2 minutes vs. 221.9 minutes, P &lt; 0.001) even after controlling for confounders in regression analysis., Conclusions: There is no increased risk of infection associated with prepping and maintenance of the external fixator during definitive internal fixation for high-energy tibial plateau fractures. These data suggest that this practice may lead to shorter operative times as well., Level of Evidence: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence., Competing Interests: The authors report no conflict of interest., (Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.)

Background: We explored the feasibility and surgeons' perceptions of the utility of a longitudinal skills performance database., Methods: A 10-station surgical skills assessment center was established at a national scientific meeting. Skills assessment volunteers (n = 189) completed a survey including opinions on practicing surgeons' skills evaluation, ethics, and interest in a longitudinal database. A subset (n = 23) participated in a survey-related interview., Results: Nearly all participants reported interest in a longitudinal database and most believed there is an ethical obligation for such assessments to protect the public. Several interviewees specified a critical role for both formal and informal evaluation is to first create a safe and supportive environment., Conclusions: Participants support the construction of longitudinal skills databases that allow information sharing and establishment of professional standards. In a constructive environment, structured peer feedback was deemed acceptable to enhance and diversify surgeon skills. Large scale skills testing is feasible and scientific meetings may be the ideal location., (Copyright © 2021 Elsevier Inc. All rights reserved.)

Objectives: Describe co-occurrence or clustering of microbial taxa in fracture-related infections to inform further exploration of infection-related interactions among them., Design: Retrospective review., Setting: Level 1 trauma center., Patients/participants: Four hundred twenty-three patients requiring surgical intervention for deep surgical site infection between January 2006 and December 2015., Intervention: None., Main Outcome Measurement: Connection between microbial taxa., Results: Methicillin-resistant Staphylococcus aureus, methicillin-sensitive Staphylococcus aureus, and coagulase-negative Staphylococcus represented the majority of monomicrobial observations (71%). Gram-negative rods, gram-positive rods, and anaerobes presented more frequently in polymicrobial infections. Enterobacter, vancomycin-sensitive Enterococcus, and Pseudomonas are present in polymicrobial infections with the highest frequencies and represent the top 3 most important nodes within the microorganism framework, with the highest network centrality scores., Conclusions: The present study indicates that there are common microbial taxa (Enterobacter, Enterococcus, and Pseudomonas) that tend to co-occur with other microbes greater than 75% of the time. These commonly co-occurring microbes have demonstrated interactive relationships in other disease pathologies, suggesting that there may be similar important interactions in fracture-related infections. It is possible that these microbial communities play a role in the persistently high failure rate associated with management of infection after trauma. Future studies are needed to study the intermicrobial interactions that explain the frequency at which taxa co-occur. Understanding and potentially disrupting these intermicrobial relationships could inform improvements in the treatment of established infections and in the prevention of infection in high-risk patients., Level of Evidence: Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence., Competing Interests: The authors report no conflict of interest., (Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.)