Clinical Outcomes of Revision Arthroscopic Capsulolabral Repair for Recurrent Anterior Shoulder Instability With Moderate Glenoid Bone Defects: A Comparison With Primary Surgery

Background: The optimal revision surgery for failed primary arthroscopic capsulolabral repair (ACR) has yet to be determined. Revision ACR has shown promising results. Purpose: To compare the functional, strength, and radiological outcomes of revision ACR and primary ACR for anterior shoulder instability. Study Design: Cohort study; Level of evidence, 3. Methods: Between March 2007 and April 2017, a total of 85 patients underwent ACR (revision: n = 23; primary: n = 62). Functional outcome scores and positive apprehension signs were evaluated preoperatively, at 1 year, and then annually. Isokinetic internal and external rotation strengths were evaluated preoperatively and at 1 year after surgery. Results: The mean follow-up was 36.5 ± 10.2 months (range, 24-105 months). There was no significant difference between the revision and primary groups in the glenoid bone defect size at the time of surgery (17.3% ± 4.8% vs 15.4% ± 5.1%, respectively; P = .197). At the final follow-up, no significant differences were found in the American Shoulder and Elbow Surgeons score (97.6 ± 3.1 vs 98.0 ± 6.2, respectively; P = .573), Western Ontario Shoulder Instability Index score (636.7 ± 278.1 vs 551.1 ± 305.4, respectively; P = .584), or patients with a positive apprehension sign (17.4% [4/23] vs 11.3% [7/62], respectively; P = .479) between the revision and primary groups. There was no significant difference between the revision and primary groups for returning to sports at the same preoperative level (65.2% vs 80.6%, respectively; P = .136) and anatomic healing failure at 1 year after surgery (13.0% vs 3.2%, respectively; P = .120). Both groups recovered external rotation strength at 1 year after surgery (vs before surgery), although the strength was weaker than in the uninvolved shoulder. In the revision group, a larger glenoid bone defect was significantly related to a positive apprehension sign (22.0% ± 3.8%) vs a negative apprehension sign (16.0% ± 3.2%; cutoff = 20.5%; P = .003). Conclusion: In patients with moderate glenoid bone defect sizes (10%-25%), clinical outcomes after revision ACR were comparable to those after primary ACR. However, significant glenoid bone loss was related to a positive remaining apprehension sign in the revision group. Surgeons should consider these findings when selecting their revision strategy for patients with failed anterior shoulder stabilization.

Developing Performance Assessment Instruments For Local Organizations in Ecological Restoration As Part of The Cross-Cutting Capacity Development (CCCD-UNDP) Project In Indonesia

Using the CCCD project as the locus of study, this paper reconstructs the empowerment process to reveal and arrange the instruments used at each empowerment stage. The performance measurement instrument was used to measure whether the organization involved in the project was related to project activities directly or indirectly. These two activities helped us compile criteria for the various organizations involved and conceptually draw the pattern of organizational relationships. Findings showed three main processes: (1) the process of identifying and selecting organizations, (2) the process of mentoring and facilitation, and (3) the process of evaluation and follow-up plan. The organizations or groups were divided into primary, secondary, and tertiary groups. Primary groups were directly related and involved in the project. Secondary groups could be involved and did not depend on funding and assistants. Tertiary groups did not need to be involved unless they had such political consequences to influence other groups. The group itself took part in decision-making about management patterns. The pattern could not be separated from the dynamics of policies, markets, and local village and supra-village politics. Based on these findings, the CCCD project confirms that a group empowerment approach must focus on the substantive aspect of achieving project goals, while the procedural aspect merely supports the administrative arrangement so objectives can be achieved more efficiently.

Performance Evaluation Study of a Novel Digital Microscopy System for the Quantitative Analysis of Bone Marrow Aspirates

Background. We report here a trial in progress for the evaluation of a novel system aimed to provide an all-digital standardized bone marrow aspirate (BMA) analysis, Scopio Labs X100, empowered by artificial intelligence (AI) based cell pre-classification. Current methods for the analysis and reporting of BMA specimens are based on analog microscopy, as whole slide imaging at x100 magnification is not practically available. The lack of uniformity between experts in the field, originating from a subjective manual review, can lead to inconsistencies in disease diagnosis and classification, and thereby affect treatment and clinical outcomes. For example, ICSH and WHO guidelines require that at least 500 cells should be counted in at least two smears when a precise percentage of an abnormal cell type is required for diagnosis and classification. It is also recommended that in order reduce imprecision from sampling error, the total number of cells counted in the differential should be increased, specifically if the abnormal cell count is very close to a critical threshold for disease stratification or response assessment. For the general evaluation of hematopoiesis, Myeloid to Erythroid (M:E) ratio is reported. Considering the complexity of the manual BMA analysis, even more so in routine laboratory settings with competitive turnaround times, a digital transformation can sustain the desired standardization, and increase sensitivity and efficiency in routine workflow. Study Design and Methods. This multisite study is taking place at: Hospital of the University of Pennsylvania (HUP), Oregon Health and Science University (OHSU), and Tel Aviv Sourasky Medical Center (TASMC). BMA analysis is performed with a manual microscope as the reference arm and in Scopio Labs X100 Full Field BMA application as the test arm (Figure 1A). Two hematopathologists at each site independently review 265 BMA specimens, including 205 with a Romanowsky stain and 60 with a Prussian Blue stain, in both the test and the reference arms. There is a 3 week washout period between arms (Figure 1B, right). ICSH guidelines were rigorously translated into a comprehensive report format used in both study arms. The report presents 27 primary and 13 secondary characteristics for the morphological assessment of BMA (Figure 1C). These include evaluation of specimen quality, evaluation of count, maturation and morphology of trilineage hematopoietic elements (myeloid, erythroid and megakaryocytic), as well as lymphocytes and plasma cells. For a repeatability study, 8 representative samples are analyzed through 20 days, 2 daily runs and 2 replicas in one site. For reproducibility study, 8 representative samples are analyzed in all sites for 5 days with 5 replicas (Figure 1B, left). The collected BMA samples hold a distribution of 55.61% males, with 2.02%, 9.46%, 16.39%, 54.73% and 17.40% of ages 13-21, 22-39, 40-55, 56-75 and >75 respectively. All samples were diagnosed by WHO criteria. Diagnoses include AML, ALL, MPN, MDS, PCN, lymphoid neoplasms, aplastic anemia, ITP and normal morphology marrow and hemodiluted samples. All samples were retrieved from the sites' bone marrow sample storage. For the method comparison study, the primary and secondary characteristics are aggregated into three primary and secondary evaluation categories of specimen quality, count, and morphology and maturation assessments (Figure 1B, left, 1C). For the primary groups, confusion matrix will be produced. For the secondary groups, contingency tables will be generated (Figure 1B, left). For the repeatability and reproducibility (R&R) studies, two-way nested ANOVA tables will be created (Figure 1, right). Primary groups will be measured for accuracy in the form of efficiency, sensitivity and specificity. Secondary groups will be measured for overall agreement. R&R will be measured for SD and CV. The introduction of Scopio's full field morphological evaluation of BMA smears, promotes an accurate diagnosis of hematological disorders including hematological malignancies, and enables a remote evaluation of BMA smears. By reviewing the entire BMA smear, and by counting a very large number of cells, this novel approach provides a new and highly accurate tool for early detection of pathological conditions, including residual disease following therapy. Figure 1 Figure 1. Disclosures Bagg: Scopio Labs: Research Funding. Raess: Scopio Labs: Research Funding. Jengehino: Scorpio Labs: Other: Partial Salary Support. Wiszniewska: Scopio Labs: Research Funding. Huynh: Scorpio Labs: Other: Salary Support. Fan: Scopio Labs: Research Funding. Bhattacharyya: Scorpio Labs: Other: Partial Salary Support. Avivi: Novartis: Speakers Bureau; Kite, a Gilead Company: Speakers Bureau. Katz: Scopio Labs: Consultancy.

Impact of Covid-19 on International Student Support

The Covid-19 pandemic caused unique challenges to international students. Student Affairs and Services (SAS) across the higher education sector played a key role in supporting students and institutions during the pandemic. This article reports the findings of an exploratory survey with SAS practitioners from around the globe on the ways in which SAS responded to the pandemic and sought to mitigate the impact of the pandemic on students in general and international students specifically. The results demonstrate that international students were among the primary groups of students impacted by the pandemic. Specific challenges identified include mental wellbeing, inability to return home, financial hardships, fear, and uncertainty. Discrimination of certain groups was also noted. SAS intervened to assist international students in navigating these challenges across world regions, including services declared essential for international student support. Finally, financial implications and the future of international student support are explored.

283 Salvage Versus Primary Robot-Assisted Radical Prostatectomy: A Propensity-Matched Comparative Effectiveness Study from A High-Volume Tertiary Centre

Aim Salvage Robot-Assisted Radical Prostatectomy (sRARP) is a potential treatment option for locally recurrent Prostate Cancer after non-surgical primary treatment. There are minimal data comparing outcomes between propensity-matched salvage and primary Robot-Assisted Radical Prostatectomy (RARP). We compare perioperative, oncological, and functional outcomes of sRARP with primary RARP and between sRARP post-whole and focal gland therapy. Method 1:1 propensity-matched comparison of 146 sRARP with primary RARP from a cohort of 3,852 consecutive patients from a high-volume tertiary centre. Results There were no significant differences in patient characteristics between the salvage and primary RARP groups. Grade III-V Clavien-Dindo complication rates were 1.3% and 0% in the salvage and primary groups, respectively (p = 0.310). Median (IQR) follow-up was 16 (10,30) and 21 (13,33) months in the salvage and primary groups, respectively. BCR rates were 30.8% and 13.7% in the salvage and primary groups, respectively (p < 0.001). Pad-free continence rates were 79.1% and 85.4% at two years in the salvage and primary groups, respectively (p = 0.160). ED rates were 95.2% and 77.4% in the salvage and primary groups, respectively (p < 0.001). Comparing the whole gland and focal gland groups, BCR rates were 33.3% and 29.1%, respectively (p = 0.687), pad-free continence rates were 66% and 89.3%, respectively (p = 0.001), and ED rates were 98.3% and 93%, respectively (p = 0.145). Conclusions SRARP has similar perioperative but inferior oncological outcomes to primary RARP. Continence rates are similar to primary RARP, but potency is worse. Perioperative and oncological outcomes of sRARP after focal gland therapy are similar but continence outcomes are superior compared to sRARP after whole gland therapy.

Developing Instagram-Based E-Poster for Learning the Concept of Alkaline Group of Periodic Table

This research aimed at developing e-poster as learning media, analyzing how students respond to the e-posters uploaded to Instagram. This R&D research utilized an ADDIE model of development consisting of five stages: analysis, design, development, implementation, and evaluation. The research took place during even semester at the Department of Chemical Education, Faculty of Education and Teacher Training, Universitas Syiah Kuala. A total of twenty-four students (4 male and 20 female) who enrolled in the course of "elements and compounds of primary groups" voluntarily took part in the research subjects. We collect the data using the following instruments: A validity assessment form, a questionnaire for students, and an active Instagram account necessary for uploading the contents and monitoring students' activity on the platform. The results show that the validity score of e-posters was 97.5%, and 89 % of students responded positively to the media, and the vast majority of students would prefer to learn using e-posters in the future. The findings indicated that e-posters could contribute as alternative learning media to help students understand the concept of alkali group elements

Historical biogeography, systematics, and integrative taxonomy of the non-Ethiopian speckled pelage brush-furred rats (Lophuromys flavopunctatus group)

Background The speckled-pelage brush-furred rats (Lophuromys flavopunctatus group) have been difficult to define given conflicting genetic, morphological, and distributional records that combine to obscure meaningful accounts of its taxonomic diversity and evolution. In this study, we inferred the systematics, phylogeography, and evolutionary history of the L. flavopunctatus group using maximum likelihood and Bayesian phylogenetic inference, divergence times, historical biogeographic reconstruction, and morphometric discriminant tests. We compiled comprehensive datasets of three loci (two mitochondrial [mtDNA] and one nuclear) and two morphometric datasets (linear and geometric) from across the known range of the genus Lophuromys. Results The mtDNA phylogeny supported the division of the genus Lophuromys into three primary groups with nearly equidistant pairwise differentiation: one group corresponding to the subgenus Kivumys (Kivumys group) and two groups corresponding to the subgenus Lophuromys (L. sikapusi group and L. flavopunctatus group). The L. flavopunctatus group comprised the speckled-pelage brush-furred Lophuromys endemic to Ethiopia (Ethiopian L. flavopunctatus members [ETHFLAVO]) and the non-Ethiopian ones (non-Ethiopian L. flavopunctatus members [NONETHFLAVO]) in deeply nested relationships. There were distinctly geographically structured mtDNA clades among the NONETHFLAVO, which were incongruous with the nuclear tree where several clades were unresolved. The morphometric datasets did not systematically assign samples to meaningful taxonomic units or agree with the mtDNA clades. The divergence dating and ancestral range reconstructions showed the NONETHFLAVO colonized the current ranges over two independent dispersal events out of Ethiopia in the early Pleistocene. Conclusion The phylogenetic associations and divergence times of the L. flavopunctatus group support the hypothesis that paleoclimatic impacts and ecosystem refugia during the Pleistocene impacted the evolutionary radiation of these rodents. The overlap in craniodental variation between distinct mtDNA clades among the NONETHFLAVO suggests unraveling underlying ecomorphological drivers is key to reconciling taxonomically informative morphological characters. The genus Lophuromys requires a taxonomic reassessment based on extensive genomic evidence to elucidate the patterns and impacts of genetic isolation at clade contact zones.

Salvage versus primary robot-assisted radical prostatectomy: a propensity-matched comparative effectiveness study from a high-volume tertiary centre

Introduction Salvage Robot-Assisted Radical Prostatectomy (sRARP) is a potential treatment option for locally recurrent Prostate Cancer after non-surgical primary treatment. There are minimal data comparing outcomes between similar-risk, propensity-matched salvage and primary Robot-Assisted Radical Prostatectomy (RARP). We compare perioperative, oncological and functional outcomes of sRARP with primary RARP and between sRARP post-whole and focal gland therapy. Methods 1:1 propensity-matched comparison of 146 sRARP with primary RARP from a cohort of 3,852 consecutive patients from a high-volume tertiary centre. Results There were no significant differences in patient characteristics between the salvage and primary RARP groups. Grade III-V Clavien-Dindo complication rates were 1.3% and 0% in the salvage and primary groups (p=0.310). Median (IQR) follow-up was 16 (10, 30) and 21 (13, 33) months in the salvage and primary groups. BCR rates were 30.8% and 13.7% in the salvage and primary groups (p<0.001). Pad-free continence rates were 79.1% and 85.4% at two years in the salvage and primary groups (p=0.160). Erectile dysfunction was 95.2% and 77.4% in the salvage and primary groups (p<0.001). On comparison of whole and focal gland groups, biochemical recurrence was 33.3% and 29.1% (p=0.687), pad-free continence rates were 66% and 89.3% (p=0.001), and ED rates were 98.3% and 93% (p=0.145). Conclusions SRARP has similar perioperative but inferior oncological outcomes to primary RARP. Continence rates are similar to primary RARP, but potency is worse. Perioperative and oncological outcomes of sRARP after focal gland therapy are similar compared to after whole gland therapy but continence outcomes are superior.

ASSESSMENT OF THE PERFORMANCE OF NATIONAL SPECIAL PROGRAMME FOR FOOD SECURITY IN NIGER STATE, NIGERIA

The study assessed the performance of the National Special Programme for Food Security (NSPFS) in Niger State, Nigeria. A total of 180 respondents were selected using multistage sampling technique. The project sites were chosen purposively comprising of all the nine sites of NSPFS in Niger State, namely; Nassarawa, Batavovogi, Lenfa-Bororo, Gidan-Mangoro, Garam, Mankangara, Lioji, Kaboji and Shambo. The respondents were selected proportionately based on each site’s activities. Data collection lasted from 15th February, 2013 to 31st August, 2013. Data were analyzed using descriptive statistics such as percentages and means, frequency distribution, performance indices computation. The results of the analysis showed that, the mean age of the beneficiaries was 47.82 years, farming experience was 30 years. The mean age for non-beneficiaries was 43.59 years, farming experience was 25 years. The results of the analysis further indicated that there was high performance in the following components: existing primary groups (100%), amount of money in the account (100%), existing modules in the site (73.53%), and loan disbursement (99.30%), based on the performance indices. Crop enterprises recorded low performance (63.61%). The study concluded that the performance of the NSPFS was high in the following components: number of primary groups existing, apex amount of money in the account, existing modules in the site, and grouping based on gender for easy accessibility, loan disbursement and farm animal enterprises. It was recommended that the NSPFS should focus more attention on mechanization, storage facilities, agro-processing, marketing, small scale irrigation, and infrastructure, because it will help the benefitting famers to actualize their pre-determined goals, it will also improve their well-being. KEYWORDS: Food, Security, Food Security, Agricultural Science

Using Bayesian Networks to identify musculoskeletal symptoms influencing the risk of developing Psoriatic Arthritis in people with psoriasis

Objectives To explore Bayesian networks (BNs) in understanding the relationships between musculoskeletal symptoms and the development of PsA in people with psoriasis. Methods Incident cases of psoriasis were identified between 1998 and 2015 from the UK Clinical Research Practice Datalink. Musculoskeletal symptoms identified by medcodes were concatenated into primary groups, each made up of several sub-groups. Baseline demographics for gender, age, body mass index (BMI), psoriasis severity, alcohol use and smoking status were also extracted. Several BN structures were composed using a combination of expert knowledge and data-oriented modelling using: 1) primary musculoskeletal symptom groups, 2) musculoskeletal symptom sub-groups and 3) demographic variables. Predictive ability of the networks using the receiver operating characteristic curve (AUC) was calculated. Results Over one million musculoskeletal symptoms were extracted for the 90,189 incident cases of psoriasis identified, of which 1409 developed PsA. The BN analysis yielded direct relationships between gender, BMI, arthralgia, finger pain, fatigue, hand pain, hip pain, knee pain, swelling, back pain, myalgia and PsA. The best BN, achieved by using the more site-specific musculoskeletal symptom sub-groups, was 76% accurate in predicting the development of PsA in a test set and had an AUC of 0.73 (95% confidence interval (CI): 0.70-0.75). Conclusion The presented BN model may be a useful method to identify clusters of symptoms that predict the development of PsA with reasonable accuracy. Using a BN approach, we have shown that there are several symptoms which are predecessors of PsA, including fatigue, specific types of pain, and swelling.