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Journal articleGill RJ, Smith DB, Raine NE, et al., 2016,
Exploring miniature insect brains using micro-CT scanning techniques
, Scientific Reports, Vol: 6, ISSN: 2045-2322The capacity to explore soft tissue structures in detail is important in understandinganimal physiology and how this determines features such as movement, behaviour and the impactof trauma on regular function. Here we use advances in micro-computed tomography (micro-CT)technology to explore the brain of an important insect pollinator and model organism, thebumblebee (Bombus terrestris). Here we present a method for accurate imaging and exploration 2of insect brains that keeps brain tissue free from trauma and in its natural stereo-geometry, andshowcase our 3D reconstructions and analyses of 19 individual brains at high resolution.Development of this protocol allows relatively rapid and cost effective brain reconstructions,making it an accessible methodology to the wider scientific community. The protocol describes thenecessary steps for sample preparation, tissue staining, micro-CT scanning and 3D reconstruction,followed by a method for image analysis using the freeware SPIERS. These image analysis methodsdescribe how to virtually extract key composite structures from the insect brain, and wedemonstrate the application and precision of this method by calculating structural volumes andinvestigating the allometric relationships between bumblebee brain structures.
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Journal articleSabharwal S, Carter AW, Rashid A, et al., 2016,
Cost analysis of the surgical treatment of fractures of the proximal humerus: an evaluation of the determinants of cost and comparison of the institutional cost of treatment with the national tariff
, Bone & Joint Journal, Vol: 98B, Pages: 249-259, ISSN: 2049-4394Aims The aims of this study were to estimate the cost of surgical treatment of fractures of the proximal humerus using a micro-costing methodology, contrast this cost with the national reimbursement tariff and establish the major determinants of cost.Methods A detailed inpatient treatment pathway was constructed using semi-structured interviews with 32 members of hospital staff. Its content validity was established through a Delphi panel evaluation. Costs were calculated using time-driven activity-based costing (TDABC) and sensitivity analysis was performed to evaluate the determinants of costResults The mean cost of the different surgical treatments was estimated to be £3282. Although this represented a profit of £1138 against the national tariff, hemiarthroplasty as a treatment choice resulted in a net loss of £952. Choice of implant and theatre staffing were the largest cost drivers. Operating theatre delays of more than one hour resulted in a loss of incomeDiscussion Our findings indicate that the national tariff does not accurately represent the cost of treatment for this condition. Effective use of the operating theatre and implant discounting are likely to be more effective cost containment approaches than control of bed-day costs.Take home message: This cost analysis of fractures of the proximal humerus reinforces the limitations of the national tariff within the English National Health Service, and underlines the importance of effective use of the operating theatre, as well as appropriate implant procurement where controlling costs of treatment is concerned.
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Journal articleBelsi A, Papi E, McGregor AH, 2016,
The impact of wearable technology on psychosocial factors of osteoarthritis management: a qualitative study
, BMJ Open, Vol: 6, ISSN: 2044-6055Objectives To identify the impact the use of wearable technology could have in patients with osteoarthritis in terms of communication with healthcare providers and patients’ empowerment to manage their condition.Design Qualitative study using focus groups with patients with osteoarthritis; data from patients’ responses were analysed using Framework Methodology.Participants 21 patients with knee osteoarthritis from the London area (age range 45–65 years) participated in a total of four focus groups. Recruitment continued until data saturation.Setting The study was conducted in a university setting.Results Patients’ responses suggested a positive attitude on the impact wearable technology could have on the management of osteoarthritis. It was perceived that the use of wearable devices would benefit patients in terms of feeling in control of their condition, providing them with awareness of their progress, empowering in terms of self-management and improving communication with their clinician.Conclusions This paper suggests positive patient perspectives on the perceived benefits wearable technology could have on the management of osteoarthritis. The data that could be collected with the use of wearable technology could be beneficial both to patients and clinicians. The information obtained from this study suggests that introducing wearable technology into patient-centred care could enhance patient experience in the field of osteoarthritis and beyond.
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Journal articleStephen JM, Halewood C, Kittl C, et al., 2016,
Posteromedial Meniscocapsular Lesions Increase Tibiofemoral Joint Laxity With Anterior Cruciate Ligament Deficiency, and Their Repair Reduces Laxity
, American Journal of Sports Medicine, Vol: 44, Pages: 400-408, ISSN: 0363-5465Background:Injury to the posteromedial meniscocapsular junction has been identified after anterior cruciate ligament (ACL) rupture; however, there is a lack of objective evidence investigating how this affects knee kinematics or whether increased laxity can be restored by repair. Such injury is often overlooked at surgery, with possible compromise to results.Hypotheses:(1) Sectioning the posteromedial meniscocapsular junction in an ACL-deficient knee will result in increased anterior tibial translation and rotation. (2) Isolated ACL reconstruction in the presence of a posteromedial meniscocapsular junction lesion will not restore intact knee laxity. (3) Repair of the posteromedial capsule at the time of ACL reconstruction will reduce tibial translation and rotation to normal. (4) These changes will be clinically detectable.Study Design:Controlled laboratory study.Methods:Nine cadaveric knees were mounted in a test rig where knee kinematics were recorded from 0° to 100° of flexion by use of an optical tracking system. Measurements were recorded with the following loads: 90-N anterior-posterior tibial forces, 5-N·m internal-external tibial rotation torques, and combined 90-N anterior force and 5-N·m external rotation torque. Manual Rolimeter readings of anterior translation were taken at 30° and 90°. The knees were tested in the following conditions: intact, ACL deficient, ACL deficient and posteromedial meniscocapsular junction sectioned, ACL deficient and posteromedial meniscocapsular junction repaired, ACL patellar tendon reconstruction with posteromedial meniscocapsular junction repair, and ACL reconstructed and capsular lesion re-created. Statistical analysis used repeated-measures analysis of variance and post hoc paired t tests with Bonferroni correction.Results:Tibial anterior translation and external rotation were both significantly increased compared with the ACL-deficient knee after posterior meniscocapsular sectioning (P <
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Journal articleKittl C, El-Daou H, Athwal KK, et al., 2016,
The role of the anterolateral structures and the ACL in controlling laxity of the intact and ACL-deficient knee
, AMERICAN JOURNAL OF SPORTS MEDICINE, Vol: 44, Pages: 345-354, ISSN: 0363-5465Background:Anterolateral rotatory instability (ALRI) may result from combined anterior cruciate ligament (ACL) and lateral extra-articular lesions, but the roles of the anterolateral structures remain controversial.Purpose:To determine the contribution of each anterolateral structure and the ACL in restraining simulated clinical laxity in both the intact and ACL-deficient knee.Study Design:Controlled laboratory study.Methods:A total of 16 knees were tested using a 6 degrees of freedom robot with a universal force-moment sensor. The system automatically defined the path of unloaded flexion/extension. At different flexion angles, anterior-posterior, internal-external, and internal rotational laxity in response to a simulated pivot shift were tested. Eight ACL-intact and 8 ACL-deficient knees were tested. The kinematics of the intact/deficient knee was replayed after transecting/resecting each structure of interest; therefore, the decrease in force/torque reflected the contribution of the transected/resected structure in restraining laxity. Data were analyzed using repeated-measures analyses of variance and paired t tests.Results:For anterior translation, the intact ACL was clearly the primary restraint. The iliotibial tract (ITT) resisted 31% ± 6% of the drawer force with the ACL cut at 30° of flexion; the anterolateral ligament (ALL) and anterolateral capsule resisted 4%. For internal rotation, the superficial layer of the ITT significantly restrained internal rotation at higher flexion angles: 56% ± 20% and 56% ± 16% at 90° for the ACL-intact and ACL-deficient groups, respectively. The deep layer of the ITT restrained internal rotation at lower flexion angles, with 26% ± 9% and 33% ± 12% at 30° for the ACL-intact and ACL-deficient groups, respectively. The other anterolateral structures provided no significant contribution. During the pivot-shift test, the ITT provided 72% ± 14% of the restraint at 45° for th
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Journal articleBates AV, McGregor AH, Alexander CM, 2016,
Reliability and minimal detectable change of gait kinematics in people who are hypermobile
, GAIT & POSTURE, Vol: 44, Pages: 37-42, ISSN: 0966-6362- Author Web Link
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- Citations: 15
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Journal articleSugand K, Mawkin M, Gupte C, 2016,
Training effect of using Touch Surgery™ for intramedullary femoral nailing
, INJURY-INTERNATIONAL JOURNAL OF THE CARE OF THE INJURED, Vol: 47, Pages: 448-452, ISSN: 0020-1383- Author Web Link
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- Citations: 25
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Journal articleCobb J, 2016,
Accuracy, precision and knee replacement: a cautionary tale
, TRENDS IN UROLOGY & MENS HEALTH, Vol: 7, Pages: 25-27, ISSN: 2044-3730 -
Journal articlePapi E, Murtagh GM, McGregor AH, 2016,
Wearable technologies in osteoarthritis: A qualitative study of clinicians’ preferences.
, BMJ Open, Vol: 6, ISSN: 2044-6055Objective This study investigates clinicians’ views of health-related wearable technologies in the context of supporting osteoarthritis (OA) long-term management. Clinicians’ preferences are critical in identifying realistic implementation strategies for such technologies.Design Qualitative study incorporating an inductive thematic analysis applied to identify key themes from clinicians’ responses.Participants Clinicians, including 4 general practitioners, 4 physiotherapists and 5 orthopaedic surgeons were interviewed.Setting The study was conducted in a University setting.Results Participants all agreed wearable technologies could positively complement their role and enhance their relationship with patients. Perceived benefits of wearable technologies included monitoring patients’ progress, treatment evaluation, monitoring compliance and informing clinical decision-making. The device should be designed to provide objective data of patients’ locomotion capability in an easy and timely fashion via a simple interface. Data should be available to both clinicians and patients to provide them with the motivation to achieve clinical goals and allow them to take ownership of their treatment. The use of technology was also seen as a way to more effectively plan treatment and manage patients’ contact time saving time and cost.Conclusions Findings support the use of wearable technologies to enhance current OA management and suggest clinical uses. Adoption of technologies could have implications on the effectiveness of treatment provided overcoming current barriers, in particular compliance with treatment.
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Journal articleMasjedi M, Mandalia R, Aqil A, et al., 2016,
Validation of the 'FeMorph' software in planning cam osteochondroplasty by incorporating labral morphology
, COMPUTER METHODS IN BIOMECHANICS AND BIOMEDICAL ENGINEERING, Vol: 19, Pages: 67-73, ISSN: 1025-5842- Author Web Link
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- Citations: 2
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Journal articleLogishetty K, Jones GG, Cobb JP, 2016,
Letter to the Editor: The John Insall Award: no functional benefit after unicompartmental knee arthroplasty performed with patient-specific instrumentation: a randomized trial
, Clinical Orthopaedics and Related Research, Vol: 474, Pages: 272-273, ISSN: 1528-1132 -
Book chapterIranpour F, Aframian A, Cobb JP, 2016,
The patellofemoral joint
, Joint Preservation in the Adult Knee, Pages: 43-53The patellofemoral joint has traditionally been poorly understood and interventions for patellofemoral joint problems have generally been less successful than those employed for the tibiofemoral joint. Pathologies affecting the patellofemoral joint in the adult can be largely divided into three groups: instability, osteochondral defects and osteoarthritis. These three conditions share a number of aetiological factors and all represent disorders of the normal mechanics of the patellofemoral articulation. As such, understanding the normal and abnormal anatomy and kinematics of the joint are vital to clinicians treating patellofemoral disorders. Treating the symptoms of these conditions without addressing the underlying disorder of kinematics will be likely to fail. In this chapter, the normal and abnormal anatomy and physiology of the joint are discussed as are the clinical features and treatments for the three commonly encountered pathologies of the patellofemoral joint.
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Book chapterTang QO, Gupte CM, 2016,
Examination of the knee
, Joint Preservation in the Adult Knee, Pages: 1-11The art of clinical examination is often forgotten with the advent of increasingly precise imaging modalities but in fact remains the most powerful tool in the surgeon’s armamentarium and is at the heart of the patient- clinician relationship. A clear examination sequence forms a fundamental tool for the diagnosis and correct treatment of knee pathology. Whilst this is important, the advanced examiner together with the history will tailor a specific exam series depending on the suspected pathology. In general, there are three broad series: one for patellofemoral/extensor mechanism pathologies; one for meniscal and chondral (articular) lesions; and one for instability. This chapter will provide an overview of advanced physical examination of the knee and outlines the most commonly used tests. Images and detailed descriptions will provide the reader with a thorough understanding of hand positions and identifying a positive sign.
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Journal articleGreenwood J, McGregor A, Jones F, et al., 2016,
Rehabilitation Following Lumbar Fusion Surgery: A Systematic Review and Meta-Analysis.
, Spine, Vol: 41, Pages: E28-E36, ISSN: 0362-2436STUDY DESIGN: A systematic review with meta-analysis. OBJECTIVE: The aim of this study was to conduct a systematic review and meta-analysis of current evidence evaluating the effectiveness of rehabilitation following lumbar fusion surgery (LFS). SUMMARY OF BACKGROUND DATA: LFS for the management of lower back pain, with(out) neurogenic leg pain, is increasing as the population ages. Clinical outcomes commonly lag behind surgical outcomes and 40% of patients experience significant back-related disability 12 months after LFS. Identifying rehabilitation strategies to improve function and quality of life following LFS is important. METHODS: A systematic review of databases were searched, including MEDLINE, CINAHL, and grey literature. Studies identified were screened for inclusion by title and abstract. Full text of eligible/potentially eligible studies was evaluated against predetermined eligibility criteria. Included studies were subjected to critical appraisal and risk of bias evaluation. The GRADE approach to quality of evidence was utilized. A meta-analysis comparing usual care with "complex rehabilitation," comprising exercise and cognitive behavioral therapy, for outcomes relating to pain, disability, fear of movement, and mental health was conducted at short and longer term (<3 and >12 months postsurgery) time points. RESULTS: Three studies were identified for the systematic review and 2 included in the meta-analysis (n = 237, female = 62%, mean age = 55). Low-quality evidence suggests that "complex rehabilitation" provides short-term improvement in disability [effect size, -0.85, 95% confidence interval (95% CI), -1.41 to -0.29] and fear avoidance behavior (-1.07, 95% CI -1.33, -0.80), compared with usual care. Low-quality evidence exists favoring "complex rehabilitation" over usual care for longer term disability (-0.84, 95% CI -1.11 to -0.58) and fear avoidance behavior (-1.40, 95% CI -1.69 to -1.12). CONCLUSIONS: A small n
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Journal articleCole JM, Wood JC, Lopes NC, et al., 2016,
Tomography of human trabecular bone with a laser-wakefield driven x-ray source
, Plasma Physics and Controlled Fusion, Vol: 58, ISSN: 1361-6587A laser-wakefield driven x-ray source is used for the radiography of human bone. The betatron motion of accelerated electrons generates x-rays which are hard (critical energy ${{E}_{\text{crit}}}>30$ keV), have small source size (<3 μm) and high average brightness. The x-rays are generated from a helium gas cell which is near-instantly replenishable, and thus the average photon flux is limited by the repetition rate of the driving laser rather than the breakdown of the x-ray source. A tomograph of a human bone sample was recorded with a resolution down to 50 μm. The photon flux was sufficiently high that a radiograph could be taken with each laser shot, and the fact that x-ray beams were produced on 97% of shots minimised failed shots and facilitated full micro-computed tomography in a reasonable time scale of several hours, limited only by the laser repetition rate. The x-ray imaging beamline length (not including the laser) is shorter than that of a synchrotron source due to the high accelerating fields and small source size. Hence this interesting laboratory-based source may one day bridge the gap between small microfocus x-ray tubes and large synchrotron facilities.
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Journal articleLangley RE, Kynaston HG, Alhasso AA, et al., 2015,
A randomised comparison evaluating changes in bone mineral density in advanced prostate cancer: luteinising hormone-releasing hormone agonists versus transdermal oestradiol.
, European Urology, Vol: 69, Pages: 1016-1025, ISSN: 1421-993XBACKGROUND: Luteinising hormone-releasing hormone agonists (LHRHa), used as androgen deprivation therapy (ADT) in prostate cancer (PCa) management, reduce serum oestradiol as well as testosterone, causing bone mineral density (BMD) loss. Transdermal oestradiol is a potential alternative to LHRHa. OBJECTIVE: To compare BMD change in men receiving either LHRHa or oestradiol patches (OP). DESIGN, SETTING, AND PARTICIPANTS: Men with locally advanced or metastatic PCa participating in the randomised UK Prostate Adenocarcinoma TransCutaneous Hormones (PATCH) trial (allocation ratio of 1:2 for LHRHa:OP, 2006-2011; 1:1, thereafter) were recruited into a BMD study (2006-2012). Dual-energy x-ray absorptiometry scans were performed at baseline, 1 yr, and 2 yr. INTERVENTIONS: LHRHa as per local practice, OP (FemSeven 100μg/24h patches). OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: The primary outcome was 1-yr change in lumbar spine (LS) BMD from baseline compared between randomised arms using analysis of covariance. RESULTS AND LIMITATIONS: A total of 74 eligible men (LHRHa 28, OP 46) participated from seven centres. Baseline clinical characteristics and 3-mo castration rates (testosterone ≤1.7 nmol/l, LHRHa 96% [26 of 27], OP 96% [43 of 45]) were similar between arms. Mean 1-yr change in LS BMD was -0.021g/cm(3) for patients randomised to the LHRHa arm (mean percentage change -1.4%) and +0.069g/cm(3) for the OP arm (+6.0%; p<0.001). Similar patterns were seen in hip and total body measurements. The largest difference between arms was at 2 yr for those remaining on allocated treatment only: LS BMD mean percentage change LHRHa -3.0% and OP +7.9% (p<0.001). CONCLUSIONS: Transdermal oestradiol as a single agent produces castration levels of testosterone while mitigating BMD loss. These early data provide further supporting evidence for the ongoing phase 3 trial. PATIENT SUMMARY: This study found that prostate cancer patients treated with transdermal oestradiol for ho
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Journal articleAframian A, Boughton OR, Auvinet E, et al., 2015,
Patellofemoral pain is a symptom, not a diagnosis
, British Medical Journal, Vol: 351, ISSN: 1468-5833 -
Journal articleMcGregor AH, Buckeridge E, Murphy AJ, et al., 2015,
Communicating and using biomechanical measures through visual cues to optimise safe and effective rowing
, Proceedings of the Institution of Mechanical Engineers Part P - Journal of Sports Engineering and Technology, Vol: 230, Pages: 246-252, ISSN: 1754-3371The use of representations of physiological parameters to an athlete and coach during training is becoming increasingly common. Their utility is enhanced when the appropriate data are captured and communicated in real time for the athlete to make training adjustments immediately. The aim of this work was to develop a biofeedback tool for ergometer rowing by creating a data acquisition system, data analysis and interpretation that could be conducted in real time and a feedback system with appropriate cues to the athlete. This fourteen year study resulted in a set of measured parameters with inferred correlations between the directly measured parameters acquired during the activity and performance and injury outcome measures. These parameters were represented through a customisable visual display in real-time during ergometer training. An athlete and coach open survey was conducted to assess the utility of the biofeedback tool. This survey found that all parties valued the feedback system since it provided a common language to identify body motion and performance parameters in a way that was accessible and meaningful to all parties as well available during training and coaching. Athletes noted that it helped them to understand body segment motion and its relation to performance and both coaches and medical staff valued this in enhancing performance and monitoring injury and injury prediction. There was also speculation that the system help to underpin coaching practice and its translation to the team. The biofeedback tool has been adopted by the British elite rowing squad.
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Conference paperPavlova A, Deane JA, Aspden R, et al., 2015,
Lumbar spine curvature varies with modic changes and disc degeneration in asymptomatic individuals
, Britspine -
Journal articleShah SIMRANA, Jin ANDI, Wilson HANNAHCP, et al., 2015,
Novel Computed Tomography-based Metric Reliably Estimates bone Strength, Offering Potentially Meaningful Enhancement in Clinical Fracture Risk Prediction
, European Journal of Medicine, Vol: 10, Pages: 214-220, ISSN: 2310-3434Osteoporosis with resultant fractures is a major global health problem with huge socioeconomicimplications for patients, families and healthcare services. Areal (2D bone mineraldensity (BMD) assessment is commonly used for predicting such fracture risk, but is unreliable,estimating only about 50% of bone strength. By contrast, computed tomography (CT) basedtechniques could provide improved metrics for estimating bone strength such as bone volumefraction (BVF; a 3D volumetric measure of mineralised bone), enabling cheap, safe and reliablestrategies for clinical application, and to help divert resources to patients identified as most likelyto benefit, meeting an unmet need.Here we describe a novel method for measuring BVF at clinical-CT like low-resolution(550µm voxel size). Femoral heads (n=8) were micro-CT scanned ex-vivo. Micro-CT data weredowngraded in resolution from 30µm to 550µm voxel size and BVF calculated at high and lowresolution. Experimental mechanical testing was applied to measure ex vivo bone strength ofsamples. BVF measures collected at high-resolution showed high correlation (correlationcoefficient r2=0.95) with low-resolution data. Low-resolution BVF metrics showed high correlation(r2=0.96) with calculated sample strength. These results demonstrate that measuring BVF at lowresolution is feasible, which also predicts bone strength. Measures of BVF should be useful for clinically estimating bone strength and fracture risk. The method needs to be validated using clinical CT scans.
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