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Aims: It is unclear whether mortality outcomes differ for patients undergoing total hip arthroplasty (THA) or total knee arthroplasty (TKA) surgery who are readmitted to the index hospital where their surgery was performed, or to another hospital. Methods: We analyzed linked hospital and death records for residents of New South Wales, Australia, aged ≥ 18 years who had an emergency readmission within 90 days following THA or TKA surgery between 2003 and 2022. Multivariable modelling was used to identify factors associated with non-index readmission and to evaluate associations of readmission destination (non-index vs index) with 90-day and one-year mortality. Results: Of 394,248 joint arthroplasty patients (THA = 149,456; TKA = 244,792), 9.5% (n = 37,431) were readmitted within 90 days, and 53.7% of these were admitted to a non-index hospital. Non-index readmission was more prevalent among patients who underwent surgery in private hospitals (60%). Patients who were readmitted for non-orthopaedic conditions (62.8%), were more likely to return to a non-index hospital compared to those readmitted for orthopaedic complications (39.5%). Factors associated with non-index readmission included older age, higher socioeconomic status, private health insurance, and residence in a rural or remote area. Non-index readmission was significantly associated with 90 day (adjusted odds ratio (aOR) 1.69; 95% confidence interval (CI) 1.39 to 2.05) and one-year mortality (aOR 1.31; 95% CI 1.16 to 1.47). Associations between non-index readmission and mortality were similar for patients readmitted with orthopaedic and non-orthopaedic complications (90-day mortality aOR 1.61; 95% CI 0.98 to 2.64, and aOR 1.67; 95% CI 1.35 to 2.06, respectively). Conclusion: Non-index readmission was associated with increased mortality, irrespective of whether the readmission was for orthopaedic complications or other conditions. Cite this article: Bone Jt Open 2024;5(1):60–68.

Classification of sheep behaviour from a sequence of tri-axial accelerometer data has the potential to enhance sheep management. Sheep behaviour is inherently imbalanced (e.g., more ruminating than walking) resulting in underperforming classification for the minority activities which hold importance. Existing works have not addressed class imbalance and use traditional machine learning techniques, e.g., Random Forest (RF). We investigated Deep Learning (DL) models, namely, Long Short Term Memory (LSTM) and Bidirectional LSTM (BLSTM), appropriate for sequential data, from imbalanced data. Two data sets were collected in normal grazing conditions using jaw-mounted and ear-mounted sensors. Novel to this study, alongside typical single classes, e.g., walking, depending on the behaviours, data samples were labelled with compound classes, e.g., walking_grazing. The number of steps a sheep performed in the observed 10 s time window was also recorded and incorporated in the models. We designed several multi-class classification studies with imbalance being addressed using synthetic data. DL models achieved superior performance to traditional ML models, especially with augmented data (e.g., 4-Class + Steps: LSTM 88.0%, RF 82.5%). DL methods showed superior generalisability on unseen sheep (i.e., F1-score: BLSTM 0.84, LSTM 0.83, RF 0.65). LSTM, BLSTM and RF achieved sub-millisecond average inference time, making them suitable for real-time applications. The results demonstrate the effectiveness of DL models for sheep behaviour classification in grazing conditions. The results also demonstrate the DL techniques can generalise across different sheep. The study presents a strong foundation of the development of such models for real-time animal monitoring.

Background: Obesity is linked to higher rates of complications; lower absolute recovery of mobility, pain, and function; and increased costs of care following total knee or hip arthroplasty (TKA, THA). The aim of this prospective cohort study was to evaluate the effectiveness of a 12-week partial meal replacement (PMR) weight loss program for people awaiting TKA or THA and living with obesity (body mass index (BMI) ≥ 30 kg/m2). Methods: The intervention was delivered remotely and included a 12-week PMR plan of 1200 calories/day, incorporating two meal replacement shakes/soups and a third suitable simple meal option. The intervention support was provided through online group education sessions, one-to-one teleconsultation with a dietitian, and access to a structured PMR App with functions for goal setting and providing educational content on diet, physical activity, and behaviour changes. Results: Of the 182 patients approached, 29 provided consent to participate, 26 participants commenced the program, and 22 participants completed the 12-week PMR plan. Completers exhibited statistically significant weight loss from baseline to 12 weeks, with a paired difference of 6.3 kg (95% CI: 4.8, 7.7; p < 0.001), with 15 out of 22 (68.2%) participants achieving at least 5% weight loss. Statistically significant reductions in HbA1c and low density lipoprotein (LDL) were observed at 12 weeks compared to baseline. Moreover, a significant increase in the proportion of participants in the action and maintenance phases of the readiness to change diet, physical activity, and weight were observed at 12 weeks. The majority of program completers (18 out of 22) expressed willingness to pay for the service if offered on a long-term basis following the arthroplasty. Conclusions: This study’s findings demonstrated that significant weight loss is achievable for people living with obesity awaiting arthroplasty following a 12-week PMR weight loss program. The remote delivery of the intervention was feasible and well accepted by people awaiting TKA or THA.

Registry randomised clinical trials (RRCTs) have the potential to provide pragmatic answers to important clinical questions. RRCTs can be embedded into large population-based registries or smaller single site registries to provide timely answers at a reduced cost compared with traditional randomised controlled trials. RRCTs can take a number of forms in addition to the traditional individual-level randomised trial, including parallel group trials, platform or adaptive trials, cluster randomised trials and cluster randomised stepped-wedge trials. From an implementation perspective, initially it is advantageous to embed RRCT into well-established registries as these have typically already overcome any issues with end point validation and adjudication. With advances in data linkage and data quality, RRCTs can play an important role in answering clinical questions in a pragmatic, cost-effective way.

Abstract Background This a priori statistical analysis plan describes the analysis for CRISTAL. Methods CRISTAL (cluster-randomised, crossover, non-inferiority trial of aspirin compared to low molecular weight heparin for venous thromboembolism prophylaxis in hip or knee arthroplasty, a registry nested study) aims to determine whether aspirin is non-inferior to low molecular weight heparin (LMWH) in preventing symptomatic venous thromboembolism (VTE) following hip arthroplasty (HA) or knee arthroplasty (KA). The study is nested within the Australian Orthopaedic Association National Joint Replacement Registry. The trial was commenced in April 2019 and after an unplanned interim analysis, recruitment was stopped (December 2020), as the stopping rule was met for the primary outcome. The clusters comprised hospitals performing > 250 HA and/or KA procedures per annum, whereby all adults (> 18 years) undergoing HA or KA were recruited. Each hospital was randomised to commence with aspirin, orally, 85–150 mg daily or LMWH (enoxaparin), 40 mg, subcutaneously, daily within 24 h postoperatively, for 35 days after HA and 14 days after KA. Crossover was planned once the registration target was met for the first arm. The primary end point is symptomatic VTE within 90 days. Secondary outcomes include readmission, reoperation, major bleeding and death within 90 days, and reoperation and patient-reported pain, function and health status at 6 months. The main analyses will focus on the primary and secondary outcomes for patients undergoing elective primary total HA and KA for osteoarthritis. The analysis will use an intention-to-treat approach with cluster summary methods to compare treatment arms. As the trial stopped early, analyses will account for incomplete cluster crossover and unequal cluster sizes. Conclusions This paper provides a detailed statistical analysis plan for CRISTAL. Trial registration Australian and New Zealand Clinical Trials Registry ACTRN12618001879257 . Registered on 19/11/2018.

BackgroundThere is a global emphasis on expanding data collection for joint replacement procedures beyond implant attributes and progression to revision surgery. Patient-reported outcome measures (PROMs) are increasingly considered as an important measure of surgical outcomes from a patient’s perspective. However, a major limitation preventing wider use of PROMs data in national data collection has been the inability to systematically collect and share electronic information with relevant stakeholders in a comprehensive and financially sustainable manner. ObjectiveThis study reports on the development of an electronic data capture and reporting system by a national registry for the collection of PROMs and the processes used to identify and overcome barriers to implementation and uptake. The study also aims to provide a cost breakdown of establishing and maintaining a nationwide electronic PROMs program. MethodsBetween 2018 and 2020, 3 governance and advisory committees were established to develop and implement a PROMs pilot program nested within a nationwide joint replacement registry. The program involved electronic collection of preoperative and 6-month postoperative data for hip, knee, or shoulder replacement surgery from 44 Australian hospitals. Resource requirements for the program included a project manager, software developers, data manager, and statistician. An online platform was tested, refined, and implemented for electronic PROMs collection with scalability considered for future expansion to all Australian hospitals and additional data fields. Technical capabilities included different access for multiple user types, patient registration, automatic reminders via SMS text messages and email, online consent, and patient outcome real-time dashboards accessible for different user groups (surgeons, patients, hospitals, and project stakeholders). ResultsDuring the PROMs pilot period there were 19,699 primary procedures undertaken with 10,204 registered procedures in the electronic system. This equated to 51.80% of people who had a joint replacement at participating hospitals during this period. Patient registration and data collection were efficient (20-30 seconds and 10-12 minutes, respectively). Engagement with the reporting dashboards (as a proportion of those who viewed their dashboard) varied by user group: 197/277 (71.1%) hospital administrators, 68/129 (52.7%) project stakeholders, 177/391 (45.3%) surgeons, and 1138/8840 patients (12.9%). Cost analysis determined an overall cost per patient of Aus $7-15 (approximately US $5-12) for 2 PROMs collections per joint replacement procedure once the program was established. ConclusionsSuccessful implementation of an orthopedic PROMs program with planned scalability for a broader national rollout requires significant funding and staffing resources. However, this expenditure can be considered worthwhile, given that collection and reporting of PROMs can drive health care improvement processes. Further consideration of strategies to improve stakeholder engagement with electronic reporting dashboards (particularly for patients and surgeons) will be critical to the ongoing success of a national PROMs program.

Abstract Background Total hip and total knee arthroplasty (THA/TKA) are increasing in incidence annually. While these procedures are effective in improving pain and function, there is a risk of complications. Methods Using data from an arthroplasty registry, we described complication rates including reasons for reoperation and readmission from the acute period to six months following THA and TKA in an Australian context. Data collection at 6 months was conducted via telephone interview, and included patient-reported complications such as joint stiffness, swelling and paraesthesia. We used logistic regression to identify risk factors for complications. Results In the 8444 procedures included for analysis, major complications were reported by 9.5 and 14.4% of THA and TKA patients, respectively, whilst minor complications were reported by 34.0 and 46.6% of THA and TKA patients, respectively. Overall complications rates were 39.7 and 53.6% for THA and TKA patients, respectively. In THA patients, factors associated with increased risk for complications included increased BMI, previous THA and bilateral surgery, whereas in TKA patient factors were heart disease, neurological disease, and pre-operative back pain and arthritis in a separate joint. Female gender and previous TKA were identified as protective factors for minor complications in TKA patients. Conclusion We found moderate rates of major and high rates of minor postoperative complications following THA and TKA in Australia and have identified several patient factors associated with these complications. Efforts should be focused on identifying patients with higher risk and optimising pre- and post-operative care to reduce the rates of these complications.

Abstract Background We are performing a combined randomised and observational study comparing internal fixation to non-surgical management for common wrist fractures in older patients. This paper describes the statistical analysis plan. Methods/design A Combined Randomised and Observational Study of Surgery for Fractures In the distal Radius in the Elderly (CROSSFIRE) is a randomised controlled trial comparing two types of usual care for treating wrist fractures in older patients, surgical fixation using volar locking plates and non-surgical treatment using closed reduction and plaster immobilisation. The primary aim of this comparative-effectiveness study is to determine whether surgery is superior to non-surgical treatment with respect to patient-reported wrist function at 12 months post treatment. The secondary outcomes include radiographic outcomes, complication rates and patient-reported outcomes including quality of life, pain, treatment success and cosmesis. Primary analysis will use a two-sample t test and an intention-to-treat analysis using the randomised arm of the study. Statistical analyses will be two-tailed and significance will be determined by p

Background: The use of placebo comparisons for randomised trials assessing the efficacy of surgical interventions is increasingly being considered. However, a placebo control is a complex type of comparison group in the surgical setting and, although powerful, presents many challenges. Objectives: To provide a summary of knowledge on placebo controls in surgical trials and to summarise any recommendations for designers, evaluators and funders of placebo-controlled surgical trials. Design: To carry out a state-of-the-art workshop and produce a corresponding report involving key stakeholders throughout. Setting: A workshop to discuss and summarise the existing knowledge and to develop the new guidelines. Results: To assess what a placebo control entails and to assess the understanding of this tool in the context of surgery is considered, along with when placebo controls in surgery are acceptable (and when they are desirable). We have considered ethics arguments and regulatory requirements, how a placebo control should be designed, how to identify and mitigate risk for participants in these trials, and how such trials should be carried out and interpreted. The use of placebo controls is justified in randomised controlled trials of surgical interventions provided that there is a strong scientific and ethics rationale. Surgical placebos might be most appropriate when there is poor evidence for the efficacy of the procedure and a justified concern that results of a trial would be associated with a high risk of bias, particularly because of the placebo effect. Conclusions: The use of placebo controls is justified in randomised controlled trials of surgical interventions provided that there is a strong scientific and ethics rationale. Feasibility work is recommended to optimise the design and implementation of randomised controlled trials. An outline for best practice was produced in the form of the Applying Surgical Placebo in Randomised Evaluations (ASPIRE) guidelines for those considering the use of a placebo control in a surgical randomised controlled trial. Limitations: Although the workshop participants involved international members, the majority of participants were from the UK. Therefore, although every attempt was made to make the recommendations applicable to all health systems, the guidelines may, unconsciously, be particularly applicable to clinical practice in the UK NHS. Future work: Future work should evaluate the use of the ASPIRE guidelines in making decisions about the use of a placebo-controlled surgical trial. In addition, further work is required on the appropriate nomenclature to adopt in this space. Funding: Funded by the Medical Research Council UK and the National Institute for Health Research as part of the Medical Research Council–National Institute for Health Research Methodology Research programme.

Abstract A sensitivity study has been performed to estimate detection limits of various atmospheric trace gases achievable by a Mars‐orbiting solar occultation Fourier transform infrared (FTIR) spectrometer. This was accomplished by first computing realistic limb transmittance spectra based on a model (T, P, VMR, and dust profiles) of the Mars atmosphere and adding appropriate noise and systematic errors based on assumed instrument design/configuration/performance. We then performed spectral fits to the resulting synthetic spectra to derive slant column abundances and their uncertainties. A profile retrieval was performed to infer limits of detection. This methodology was applied to a Mars‐orbiting FTIR solar occultation spectrometer covering the 850–4,300 cm−1 spectral region at 0.025‐cm−1 resolution. We conclude that most gases can be retrieved with a single‐occultation sensitivity of 20–100 ppt. But this sensitivity varies considerably with the dust loading, especially for gases whose strongest absorption bands are toward higher wavenumbers where scattering is large. We conclude that for CH4, the ν4 band centered at 1,305 cm−1, despite being more than 2 times weaker than the ν3 band centered at 3,015 cm−1, offers better sensitivity due to its close spectral proximity to the dust extinction minimum. We also conclude that for the purpose of CH4 detection, a high‐resolution (0.025 cm−1) broadband instrument would have a substantial advantage over a medium‐resolution (0.15 cm−1) instrument, despite the latter having a much larger signal‐to‐noise ratio.

Introduction Patient comobidity at time of primary joint replacement (JR) impacts on outcomes including revision and mortality. Understanding changes in comorbidity profiles is important when assessing change in outcomes over time. Most arthroplasty registries have limited comorbidity information due to their minimum dataset. One approach to obtaining additional comorbidity data is linking registry data with national administrative data. Objectives and Approach Objectives were to quantify pre-operative comorbidity profile of patients undergoing primary total hip replacement (THR) and total knee replacement (TKR) for osteoarthritis. Also, to examine temporal trends in individual comorbidities for THR and TKR patients. National pharmaceutical dispensing data were linked with THR and TKR arthroplasty patients. Medication dispensing histories in 12-months preceding JR (2003-2017) for 237,333 THR and 394,965 TKR patients, were mapped to 47 comorbidity classes using the Rx-Risk-V measure - a pharmacy-based measure of comorbidity. Comorbidity scores were calculated by summing comorbidity categories for individual patients. Trends in comorbidity scores/categories were described, with comorbidity information presented by PBS beneficiary category (concessional/general), stratified by age (

Introduction Infection is a major complication following joint replacement (JR) surgery. However, little data exist on baseline use of antibiotics following primary JR and how use changes with subsequent revision surgery. Objectives & Approach Our study objectives were to describe community use of antibiotics before and after primary total hip replacement (THR) and change in use pre and post revision procedure. Registry data were linked with national medication dispensing data using probabilistic record linkage. Patients with THR for osteoarthritis in a private hospital between 1999 and 2017 were included. Three groups were analysed: patients with primary procedures revised for infection, revised for non-infection reasons and those not revised. Rate of antibiotic dispensing/month was calculated as number of patients dispensed at least one antibiotic in a given month divided by number of patients at-risk. Results There were 102,577 patients included in the non-revised group, 3,156 revised for non-infection and 520 revised for infection. Prior to primary THR, baseline antibiotic dispensing rate was 9-11%/month in all groups. Post-primary rates were similar (10-11%) for non-revised and revised non-infection patients but higher (16-17%) for revised-infection patients. In 1, 6 and 12 months preceding revision for infection, antibiotic use was 55%, 27% and 22%, respectively. For patients revised for non-infection, antibiotic use was 21%, 14%, 13%, respectively. One-month following revision for infection, 82% of patients were dispensed antibiotics, remaining high (38%) at 6-months and 28% at 12-months. In the revision non-infection group, antibiotic use was 48% first month post-surgery, reducing rapidly to 15% at 6-months. Conclusion / Implications Non-revision and revision non-infection patients had similar antibiotic dispensing before and after surgery. Revision infection patients however, maintained higher antibiotic dispensing post-primary, pre and post revision. This may reflect either ongoing infection, need for long-term suppressive therapy or reluctance of treating physicians to terminate treatment.

Introduction Monitoring of joint replacement (JR) data from the Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR) has reduced revision rates and improved surgical practice. Outcome assessment post-arthroplasty is limited however, to revision (reoperation) surgery and mortality outcomes. The AOANJRR National Data Linkage project seeks to broaden the scope of outcomes investigation in Australia by linking registry and health administrative datasets. Objectives and Approach Using linked registry and administrative data, the project seeks to describe and quantify national/regional trends and variation in major complications (infection, dislocation, arthrofibrosis, chronic pain, venous thromboembolism, cardiac events), malignancy and health service utilisation (readmissions, emergency encounters and inpatient rehabilitation) following hip, knee and shoulder joint replacement surgery. Evidence will be generated on how these outcomes are associated with and vary according to patient, surgical, implant, hospital and pharmacological factors. As Australia lacks a national identifier, seven linkage agencies are probabilistically linking AOANJRR hip, knee and shoulder replacement data (1999-2017) with 20 datasets. Datasets include government-subsidised health services, procedural and prescription data. Hospital separations and emergency attendance data from Australia’s eight jurisdictions together with national cancer registry and rehabilitation service data are also planned for linkage. Linked data are maintained in a secure remote access computing environment. Results To date, national Medicare Benefits Schedule, Pharmaceutical Benefits Scheme and the Australian Cancer Database data have been linked with >900,000 AOANJRR patients, representing 607.6 million health service records (1999-2018), 467.7 million prescriptions (2002-2018) and 184,000 cancer records, respectively. Remaining linked data will be available in mid-2020. Some initial summary results across a selected range of studies will be presented. Conclusion / Implications This national data-linkage program will identify areas for improvement in joint replacement surgery and modifiable risk factors contributing to poor patient outcomes.

Introduction As the population ages, increasing numbers of older adults are undergoing surgery. Outcomes for older people are known to be worse than younger people following surgical procedures, and identifying which patients stand to benefit from surgery can be challenging. Frailty is recognised as a major contributor to poor outcomes, however assessing frailty clinically is time-consuming and not routinely undertaken. Using data available from electronic medical records can potentially provide the opportunity to routinely screen for frailty electronically at time of admission. Objectives and Approach This population-based external validation study aimed to: 1. assess the performance of the Hospital Frailty Risk Score (HFRS) in the prediction of adverse outcomes (mortality, prolonged length of stay (LOS) and 28-day readmission), 2. to determine optimal age-groups and lookback periods and 3. compare HFRS performance against the Charlson Comorbidity Index (CCI). Hospital and death data for individuals (n=487,197) aged >50 years admitted under a surgical specialty to all public/private hospitals in NSW, Australia, 2013-2017 were linked. Logistic regression models were tested for each outcome of interest. Area under receiving operator curve (AUC) and Akaike information criterion (AIC) were assessed for each model. Results For prediction of 30-day, all models performed better than age and sex alone; however adjusting for CCI (AUC 0.76) provided marginally better prediction than adjusting for HFRS (AUC 0.75). Models consistently performed better in the younger age-group (50-65), providing excellent discrimination (AUC 0.82). In contrast, all models had poor ability to predict prolonged-LOS (AUC range 0.62- 0.63) or readmission (AUC range 0.62-0.65). Using a 5-year lookback period did not improve model discrimination over using a 2-year period. Conclusion / Implications Adjusting for frailty using the HFRS did not improve prediction of 30-mortality over that achieved by the CCI. Neither HFRS nor CCI were useful for predicting prolonged-LOS r 28-day unplanned readmission.

ABSTRACT: Knowledge of the distribution of total phosphorus (P) content in native soils provides information on the management of ecosystem, land capability for agriculture, environmental quality, and biodiversity conservation. We mapped the spatial distribution of total P concentrations in topsoils (0-30 cm) of uncultivated (native) areas in Brazil. We obtained data on native total P of the southern, south-eastern, and north-eastern regions from reports of exploratory projects developed between 1960s and 1970s by EMBRAPA and by the RADAM Brazil Project. We estimated data from the central-western and northern regions from the relationship between total P and soil properties (Fe, Al, C and clay content), based on the RADAM Brazil Project. Soil total P varied widely (< 25 to > 500 mg kg–1) in all regions in Brazil. Higher concentrations (> 500 mg kg–1) were observed in southern region compared to most of the rest of the country (< 200 mg kg–1), while the Cerrado (Central), Amazon (North) and Caatinga (Northeast) biomes are very poor in total P. This first national native soil total P map provides a valuable baseline for understanding the historical patterns of agriculture expansion in Brazil. It allows quantifying the effect of agriculture expansion and future cropping systems on soil available P content and legacy P, targeting regional soil-crop specific strategies for optimization of ecosystem services, and mitigating potential environmental risk due to P transference to water bodies.

Objectives To determine the reporting quality of published randomised controlled trial (RCT) protocols before and after the Standard Protocol Items: Recommendations for Interventional Trials (SPIRIT) statement (2013), and any association with author, trial or journal factors.Design Methodological study.Data sources MEDLINE, Embase and CENTRAL were electronically searched using optimised search strategies.Eligibility criteria Protocols written for an RCT of living humans, published in full text in a peer-reviewed journal and published in the English language.Main outcome Primary outcome was the overall proportion of checklist items which were adequately reported in RCT protocols published before and after the SPIRIT statement.Results 300 RCT protocols were retrieved; 150 from the period immediately before the SPIRIT statement (9 July 2012 to 28 December 2012) and 150 from a recent period after the SPIRIT statement (25 January 2019 to 20 March 2019). 47.9% (95% CI, 46.5% to 49.3%) of checklist items were adequately reported in RCT protocols before the SPIRIT statement and 56.7% (95% CI, 54.9% to 58.5%) after the SPIRIT statement. This represents an 8.8% (95% CI, 6.6% to 11.1%; p

West African rainfed agriculture is highly vulnerable to climate variability and change. Global warming is projected to result in higher regional warming and have a strong impact on agriculture. This study specifically examines the impact of global warming levels (GWLs) of 1.5°, 2° and 3 °C relative to 1971–2000 on crop suitability over West Africa. We used 10 Coupled Model Intercomparison Project Phase5 Global Climate Models (CMIP5 GCMs) downscaled by Coordinated Regional Downscaling Experiment (CORDEX) Rossby Centre’s regional Atmospheric model version 4, RCA4, to drive Ecocrop, a crop suitability model, for pearl millet, cassava, groundnut, cowpea, maize and plantain. The results show Ecocrop simulated crop suitability spatial representation with higher suitability, observed to the south of latitude 14°N and lower suitability to its north for 1971–2000 for all crops except for plantain (12°N). The model also simulates the best three planting months within the growing season from September-August over the past climate. Projected changes in crop suitability under the three GWLs 1.5–3.0 °C suggest a spatial suitability expansion for legume and cereal crops, notably in the central southern Sahel zone; root and tuber and plantain in the central Guinea-Savanna zone. In contrast, projected decreases in the crop suitability index value are predicted to the south of 14°N for cereals, root and tuber crops; nevertheless, the areas remain suitable for the crops. A delay of between 1-3 months is projected over the region during the planting month under the three GWLs for legumes, pearl millet and plantain. A two month delay in planting is projected in the south, notably over the Guinea and central Savanna zone with earlier planting of about three months in the Savanna-Sahel zones. The effect of GWL2.0 and GWL3.0 warming in comparison to GWL1.5 °C are more dramatic on cereals and root and tuber crops, especially cassava. All the projected changes in simulated crop suitability in response to climatic variables are statistically significant at 99% confidence level. There is also an increasing trend in the projected crop suitability change across the three warming except for cowpea. This study has implications for improving the resilience of crop production to climate changes, and more broadly, to food security in West Africa.

Abstract Background Population-based patterns of care studies are important for trauma care but conducting them is expensive and resource-intensive. Linkage of routinely collected administrative health data may provide an efficient alternative. The aims of this study are to describe the rehabilitation pathway for trauma survivors and to analyse the brain injury rehabilitation outcomes in the two care settings (specialist brain injury and non-specialist general rehabilitation units). Methods This is an observational study using routinely collected registry data (New South Wales Trauma Registry linked with the Australasian Rehabilitation Outcomes Centre Inpatient Dataset). The study cohort includes 268 road trauma patients who were admitted to trauma services between 2009 and 2012 and received inpatient rehabilitation because of a brain injury. Results Of those who need inpatient rehabilitation, 62% (n = 166) were admitted to specialist units with the remainder (n = 102) admitted to non-specialist units. Those admitted to a specialist units were younger (p 0.001) but at a cost of longer length of stay (median 47 vs 24 days, p

Current estimates of the global land carbon sink contain substantial uncertainties on interannual timescales which contribute to a non-closure in the global carbon budget (GCB) in any given year. This budget imbalance (BIM) partly arises due to the use of imperfect models which are missing or misrepresenting processes. One such omission is the separate treatment of downward direct and diffuse solar radiation on photosynthesis. Here we evaluate and use an improved high-resolution (6-hourly), gridded dataset of surface solar diffuse and direct fluxes, over 1901–2017, constrained by satellite and ground-level observations, to drive two global land models. Results show that tropospheric aerosol–light interactions have the potential for substantial land carbon impacts (up to 0.4 PgCyr-1 enhanced sink) at decadal timescales, however large uncertainties remain, with models disagreeing on the direction of change in carbon uptake. On interannual timescales, results also show an enhancement of the land carbon sink (up to 0.9 PgCyr-1) and subsequent reduction in BIM by 55% in years following volcanic eruptions. We therefore suggest GCB assessments include this dataset in order to improve land carbon sink estimates.

Abstract Objectives: 1) Describe probabilistic linkage (PL) for road trauma and rehabilitation records in New South Wales (NSW) Australia. 2) Determine the accuracy of linkage for these records. Methods: Data were extracted from the NSW Trauma Registry for all road trauma admissions for the years 2009–2012 and from Australasian Rehabilitation Outcomes Centre for January 2009 to June 2013. PL was performed using: age; sex; residential postcode; and date of acute discharge = date of admission to rehabilitation. False matches were cases that linked but were not true matches; they were determined by manual review. Reasons for incomplete linkages were explored. The benefits and limitations of the linked study dataset are described. Results: Of 3,256 road trauma records, 683 were matched to rehabilitation records. Using the field of ‘discharge destination’ from the trauma records, 265 patients with unmatched records were discharged to inpatient rehabilitation (missed matches). This gave an overall 72% linkage rate (or sensitivity) using PL. There were 16 cases of false matches, giving a specificity of 99%. Conclusion: It was feasible to use PL to link road trauma and rehabilitation datasets in the absence of identifiers. However, this needed to be combined with careful manual review before the linked dataset could be used to make inferences on trauma rehabilitation outcomes. Implication: PL may be a cost‐effective way to capture inpatient rehabilitation outcomes of multi‐trauma patients.

Lack of evidence contributes to unnecessary variation in treatment costs and outcomes. This study aimed to identify from interventions historically used for total knee or hip arthroplasty (TKA, THA): i) if routine use is supported by high-level evidence; ii) whether surgeon use aligns with the evidence.Part 1: Systematic search of electronic library databases for systematic reviews and practice guidelines concerning seven acute-care interventions. Intervention-specific recommendations concerning routine use were extracted by assessors. Part 2: Prospective medical record audit of the acute-care received by 1900 patients involving 120 orthopaedic surgeons. Surgeon use per intervention was summarized using caterpillar plots. Surgeon-specific routine and non-routine use was defined as use in ≥ 90% and ≤ 10% of patients, respectively. Primary analysis included only surgeons contributing ≥ 10 patients.Continuous passive motion (TKA): Routine use not recommended; 85.7% of surgeons did not use it routinely. Tranexamic Acid: Routine use recommended; 26.9% of surgeons used it routinely. Cryotherapy: Routine use not recommended; 45.7% of surgeons used it routinely for TKA; 31.8% used it routinely for THA. Intra-articular drainage: Routine use not recommended for TKA, but possible benefits for THA; 5.7% of surgeons used it routinely for TKA, 0.0% used it routinely for THA. Antibiotic loaded bone cement: Routine use for TKA not supported, recommendations for use for THA are inconsistent; 90.0% of surgeons used it routinely for TKA, 100.0% used it routinely for THA. Patella resurfacing (TKA): No recommendation could be made; 57.1% of surgeons routinely resurfaced the patella. Indwelling urinary catheterisation: Routine use recommended; 59.6% of surgeons used it routinely.Recommendations for routine use or not exist for some of the acute-care interventions examined. Surgeon practices vary widely even in the presence of high-level recommendations. It is unclear whether further evidence alone would lessen unwarranted practice variation.

‘Is your edition really necessary?’ is one of those questions which are so searching that they are rarely asked in polite intellectual society. It comes from the best of sources, and it is important not least because it raises fundamental questions—about why editing of a certain sort is necessary and about the criteria according to which it is carried out. Why, indeed, should anyone undertake critical editing? These questions can be addressed in several ways. This article addresses them by way of considering an edition which, it will be seen, is necessary. For Noel Malcolm’s is the first successful attempt to produce a critical-text edition of Leviathan. Here the reader is offered gold rather than base metal, and in considering such work it cannot be out of the way to ask the questions, both particular and general, that arise from reflecting on it. Neither can it be untimely to do so just now, when textual scholars in the West are becoming more conscious of the basic fact that their practices are not the only ones.

Purpose. To report the trends in the incidence of typical and atypical femoral fractures (AFF) in patients aged >50 years from 2009 to 2014 and in the prescription of bisphosphonates for osteoporosis from 2001 to 2013 in Australia. Methods. 175 patients aged >50 years presenting to our hospital with an AO type 32 femoral shaft fracture between October 2009 and October 2014 were identified using a trauma database. Of them, 21 male and 110 female patients with a mean age of 75 years were reviewed. Radiographs were reviewed by 2 investigators blinded to the use of bisphosphonates. The femoral shaft fractures were classified as typical or atypical using the American Society of Bone and Mineral Research definition, and their annual incidence was compared. The trend and number of prescriptions for various bisphosphonates in Australia was determined using the Pharmaceutical Benefits Scheme statistics from 2001 to 2013. Results. Of the 131 femoral shaft fractures, 65 were typical and 66 were atypical subtrochanteric (n=19) or diaphyseal (n=47) fractures that were complete (n=60) or incomplete (n=6). Four patients had sequential bilateral AFF. The 66 AFFs accounted for 5% of hip and shaft fractures. Women accounted for 80% of all femoral shaft fractures and 95% of AFF. The proportion of AFF was higher in women than men (63/110 vs. 3/21, relative risk=3.95, 95% CI=1.37–11.39, p=0.0006). The mean length of hospital stay was 9.7 days shorter in the AFF patients (14.1 vs. 23.8 days, 95% CI=2.6–16.8 days, p=0.008). Patients with AFF were 8 years younger than those with proximal femoral fracture (73 vs. 81 years, p50 years. Women accounted for 80% of all femoral shaft fractures and 95% of AFF. The incidence of AFF was no longer increasing possibly related to decreased prescription of bisphosphonates in preceding years.

Categorical time series are time-sequenced data in which the values at each time point are categories rather than measurements. A categorical time series is considered stationary if the marginal distribution of the data is constant over the time period for which it was gathered and the correlation between successive values is a function only of their distance from each other and not of their position in the series. However, there are many examples of categorical series which do not fit this rather strong definition of stationarity. Such data show various nonstationary behavior, such as a change in the probability of the occurrence of one or more categories. In this paper, we introduce an algorithm which corrects for nonstationarity in categorical time series. The algorithm produces series which are not stationary in the traditional sense often used for stationary categorical time series. The form of stationarity is weaker but still useful for parameter estimation. Simulation results show that this simple algorithm applied to a DAR(1) model can dramatically improve the parameter estimates.

The prevalence of Low Back Pain (LBP) in cricketer's was determined and possible causative factors were investigated. Questionnaires were sent to 110 cricketers playing for their first times of both clubs and schools during the 1991/92 season. The return response was 90% with a prevalence of LBP at 61.6%. Of these 78.7 % cited cricket as being the primary cause of their LBP. The injuries were predominantly grade 1 (72.1%), followed by grade 3 (23.1 %) and grade 2 (6.6%). Grading was made according to the effect the pain had on the cricketers game. Fast bowlers proved to be more at risk of developing LBP with a group prevalence of 75.6% followed by wicket keepers at 63.6%, batsmen at 56.8% and slow bowlers at 48.1%. Cricketers had rather a poor general knowledge of ways of protecting their backs. Recommendations were made to help reduce the high prevalence of LBP, especially amongst Fast bowlers and in cricketers in general.