Climate change as observed through the IMS radionuclide station in Spitzbergen.

The International Monitoring System (IMS), installed and maintained by the Comprehensive Nuclear-Test-Ban Treaty Organization (CTBTO) with the support of States Signatories, is a global system of monitoring stations based on four complementary technologies: seismic, hydroacoustic, infrasound and radionuclide. One of the IMS radionuclide stations is located in Spitzbergen, the largest island of the Norwegian Svalbard Archipelago, which borders the Barents Sea and the Northern Atlantic Ocean. It has been demonstrated that signs of climate change are particularly noticeable in that region. As many other radionuclides observed in environmental measurements, 212Pb is always observed at IMS stations, in varying quantities. This is also the case for the IMS station RN49, Spitzbergen, where it can be demonstrated that the average concentration of the measured lead 212Pb increases. This is observable specifically October through December. This paper demonstrates the asset of IMS data to study climate change effects. Our conclusions are supported by global temperature anomaly data from NOAA's Global Surface Temperature Analysis, covering the period 1850 to 2023.

Excessive posterior pelvic tilt from preoperative supine to postoperative standing after total hip arthroplasty.

Aims: Excessive posterior pelvic tilt (PT) may increase the risk of anterior instability after total hip arthroplasty (THA). The aim of this study was to investigate the changes in PT occurring from the preoperative supine to postoperative standing position following THA, and identify factors associated with significant changes in PT. Methods: Supine PT was measured on preoperative CT scans and standing PT was measured on preoperative and one-year postoperative standing lateral radiographs in 933 patients who underwent primary THA. Negative values indicate posterior PT. Patients with > 13° of posterior PT from preoperative supine to postoperative standing (ΔPT ≤ -13°) radiographs, which corresponds to approximately a 10° increase in functional anteversion of the acetabular component, were compared with patients with less change (ΔPT > -13°). Logistic regression analysis was used to assess preoperative demographic and spinopelvic parameters predictive of PT changes of ≤ -13°. The area under receiver operating characteristic curve (AUC) determined the diagnostic accuracy of the predictive factors. Results: PT changed from a mean of 3.8° (SD 6.0°)) preoperatively to -3.5° (SD 6.9°) postoperatively, a mean change of -7.4 (SD 4.5°; p < 0.001). A total of 95 patients (10.2%) had ≤ -13° change in PT from preoperative supine to postoperative standing. The strongest predictive preoperative factors of large changes in PT (≤ -13°) from preoperative supine to postoperative standing were a large posterior change in PT from supine to standing, increased supine PT, and decreased standing PT (p < 0.001). Flexed-seated PT (p = 0.006) and female sex (p = 0.045) were weaker significant predictive factors. When including all predictive factors, the accuracy of the AUC prediction was 84.9%, with 83.5% sensitivity and 71.2% specificity. Conclusion: A total of 10% of patients had > 13° of posterior PT postoperatively compared with their supine pelvic position, resulting in an increased functional anteversion of > 10°. The strongest predictive factors of changes in postoperative PT were the preoperative supine-to-standing differences, the anterior supine PT, and the posterior standing PT. Surgeons who introduce the acetabular component with the patient supine using an anterior approach should be aware of the potentially large increase in functional anteversion occurring in these patients.

A calibration procedure for beta-gamma coincidence detector-systems using four radioxenon spikes.

The determination of activity concentrations of the CTBT-relevant radioxenon relies on a robust calibration method. A procedure is outlined using four radioxenon spikes for beta-gamma detector-systems with 4π geometry. Detection efficiencies of beta-gamma coincidences in the net count calculation method, including the interference matrix between radioxenon and radon, are determined by three measurement channels: beta singles, gamma singles and beta-gamma coincidences, without reference activity values.

Patient-reported impairment following TKA is reduced when a computationally simulated predicted ideal alignment is achieved.

PURPOSE: Joint dynamics following Total Knee Arthroplasty (TKA) may influence patient-reported outcome. Simulations allow many knee alignment approaches to a single patient to be considered prior to surgery. The simulated kinematics can be matched to patient-reported outcome to predict kinematic patterns most likely to give the best outcome. This study aims to validate one such previously developed algorithm based on a simulated deep knee bend (the Dynamic Knee Score, DKS). METHODS: 1074 TKA patients with pre- and post-operative Computerised Tomography (CT) scans and 12-month post-operative Knee Injury and Osteoarthritis Outcomes (KOOS) Scores were identified from the 360 Med Care Joint Registry. Landmarking and registration of implant position was performed on all CT scans, and each of the achieved TKAs was computationally simulated and received a predictive outcome score from the DKS. In addition, a set of potential alternative surgical plans which might have been followed were simulated. Comparison of patient-reported issues and DKS score was evaluated in a counter-factual study design. RESULTS: Patient-reported impairment with the knee catching and squatting was shown to be 30% lower (p = 0.005) and 22% lower (p = 0.026) in patients where the best possible DKS result was the one surgically achieved. Similar findings were found relating attainment of the best tibial slope and posterior femoral resection DKS plans to patient-reported difficulty straightening the knee (40% less likely, p < 0.001) and descending stairs (35% less likely, p = 0.006). CONCLUSION: The DKS has been shown to correlate with presence of patient-reported impairments post-TKA and the resultant algorithm can be applied in a pre-operative planning setting. Outcome optimization in the future may come from patient-specific selection of an alignment strategy and simulations may be a technological enabler of this trend. LEVEL OF EVIDENCE: III (Retrospective Cohort Study).

Overview of temporary radioxenon background measurement campaigns conducted for the CTBTO between 2008 and 2018.

The Comprehensive Nuclear-Test-Ban Treaty (CTBT) specifies that an overall network of at least 40 International Monitoring System (IMS) stations should monitor the presence of radioxenon in the atmosphere upon its entry into force. The measurement of radioxenon concentrations in the air is one of the major techniques to detect underground nuclear explosions. It is, together with radionuclide particulate monitoring, the only component of the network able to confirm whether an event originates from a nuclear test, leaving the final proof to on-site inspection. Correct and accurate interpretation of radioxenon detections by State Signatories is a key parameter of the verification regime of the Preparatory Commission for the Comprehensive Nuclear-Test-Ban Treaty Organization (CTBTO). In this context, the discrimination between the highly variable radioxenon background generated by normal operations of nuclear facilities and CTBT-relevant events is a challenging, but critical, task. To this end, the radioxenon background that can be expected at IMS noble gas systems must be sufficiently characterized and understood. All activities conducted to study the global radioxenon background are focused on the calibration and performance of the verification system as described in the Treaty. The unique CTBTO noble gas system network is designed to optimally covering the globe. By the end of 2019, 31 systems were put in operation, 25 of which being already certified. It took two decades from the first experimental setup of noble gas system in the field to reach this stage of maturity. In the meantime, it was an urgent need to gain empirical evidence of atmospheric radioxenon concentrations with the full spectrum of characteristics that IMS noble gas systems may be observing. This experience was significantly advanced through temporary measurement campaigns. Their objective was to gain the additional necessary knowledge for a correct understanding and categorization of radioxenon detections. The site selection for these campaigns put emphasis on regions with low coverage by the initially few experimental noble gas systems at IMS locations or where potential interferences with normal background might be observed. Short-term measurements were first initiated in 2008. Sites of potential interest were identified, and campaigns up to few weeks were performed. Based on the findings of these short campaigns, transportable systems were procured by the CTBTO. Longer temporary measurement campaigns were started afterwards and operated by local hosts in different regions of the globe. Site selections were based on purely scientific criteria. Objectives of the measurement campaigns were continually reassessed, and projects were designed to meet the scientific needs for radioxenon background understanding as required for nuclear explosion monitoring. As of today, several thousands of samples have been collected and measured. Spectra of temporary measurement campaigns were (and are still) analysed in the International Data Centre (IDC). As they are not part of the CTBT monitoring system, no IDC product is generated. Analysis results are stored in a non-operational database of the CTBTO and made available, together with raw data, to authorized users of States Signatories through a Secure Web Portal (SWP) and to scientific institutions for approved research projects through a virtual Data Exploitation Centre (vDEC) after signing a cost-free confidentiality agreement (https://www.ctbto.org/specials/vdec). This paper aims at providing an overview of the temporary measurement campaigns conducted by the CTBTO since the very first field measurements. It lays out scientific results in a systematic approach. This overview demonstrates the asset of radioxenon background measurement data that have been collected with a wide variety of characteristics that may be observed at IMS stations. It bears a tremendous opportunity for development, enhancement and validation of methodologies for CTBT monitoring. In 2018, a campaign started in Japan with transportable noble gas systems in the vicinity of the IMS station RN38 in Takasaki. It will be described separately once the measurements are completed.

Characterisation of Xe-133 background at the IMS stations in the East Asian region: Insights based on known sources and atmospheric transport modelling.

Radioxenon can be produced with a high fission yield during a nuclear explosion, making it an important tracer to demonstrate the nuclear origin of an explosion. For this reason, it is continuously monitored by the Comprehensive Nuclear-Test-Ban Treaty Organization (CTBTO) as part of the verification regime. Radioxenon is emitted by civil nuclear facilities, like nuclear power plants (NPPs) or isotope production facilities (IPFs), providing significant but variable contribution to the noble gas background. The discrimination between CTBT-relevant radioxenon detections and the background is then a challenging task. This work aims at estimating the radioxenon background at 8 East Asian noble gas stations of the International Monitoring Systems (IMS) (out of 26 certified and 14 others foreseen) based on known sources and atmospheric transport modelling (ATM). For the purpose of this study, the transportable system in Mutsu, Japan, was also included. The results demonstrate a predominant contribution of NPPs to the radioxenon background at most of the East Asian IMS stations, especially during summertime. In autumn, as a result of large-scale atmospheric circulation, the contribution of remote IPFs starts to dominate. In the summertime, up to 80% of the Xe-133 detections at a station may be explained by contributions from NPPs. The detections even rise to 100% in some specific cases. At some stations under investigation in this study, a transition from NPP to IPF domination is observed in September and continues during the autumn season. It has also been shown that, for some stations, simulated concentrations above the detection limit may include observable contributions from up to 19 different sources per daily sample; at the same time the sample being sensitive to 80 or more possible sources of radioxenon. This indicates that the accumulation of many weak sources can lead to a measurable result in a single air sample. This might also explain observations at very remote stations. Another important conclusion is that, despite limited knowledge about release patterns of NPPs, the agreement between simulated and measured values was good in many cases. Availability of IMS measurements allowed for validation of simulations. This comparison revealed that approximately 76% of simulated values were underestimated. Based on the paired t-test, a 95% confidence interval for the true mean difference between measurements and simulations was constructed. It was estimated that for data dominated by NPPs contribution (i.e. NPPs contribution exceeds 70%), the overall uncertainty of simulated results lies between 0.07 and 0.10 mBq/m3. For data dominated by IPFs contribution (i.e. IPFs contribution exceeds 70%), the uncertainty for the simulations is in the range between 0.03 and 0.12 mBq/m3.

Modular dual-mobility articulations in patients with adverse spinopelvic mobility.

AIMS: Adverse spinal motion or balance (spine mobility) and adverse pelvic mobility, in combination, are often referred to as adverse spinopelvic mobility (SPM). A stiff lumbar spine, large posterior standing pelvic tilt, and severe sagittal spinal deformity have been identified as risk factors for increased hip instability. Adverse SPM can create functional malposition of the acetabular components and hence is an instability risk. Adverse pelvic mobility is often, but not always, associated with abnormal spinal motion parameters. Dislocation rates for dual-mobility articulations (DMAs) have been reported to be between 0% and 1.1%. The aim of this study was to determine the early survivorship from the Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR) of patients with adverse SPM who received a DMA. METHODS: A multicentre study was performed using data from 227 patients undergoing primary total hip arthroplasty (THA), enrolled consecutively. All the patients who had one or more adverse spine or pelvic mobility parameter had a DMA inserted at the time of their surgery. The mean age was 76 years (22 to 93) and 63% were female (n = 145). At a mean of 14 months (5 to 31) postoperatively, the AOANJRR was analyzed for follow-up information. Reasons for revision and types of revision were identified. RESULTS: The AOANJRR reported two revisions: one due to infection, and the second due to femoral component loosening. No revisions for dislocation were reported. One patient died with the prosthesis in situ. Kaplan-Meier survival rate was 99.1% (95% confidence interval 98.3 to 100) at 14 months (number at risk 104). CONCLUSION: In our cohort of patients undergoing primary THA with one or more factor associated with adverse SPM, DM bearings conferred stability at two years' follow-up. Cite this article: Bone Joint J 2022;104-B(7):820-825.

Correctability of the knee joint observed under a stressed state.

BACKGROUND: Well-balanced postoperative knee joints are often based on subjective 'feel' of experienced surgeons rather than quantifiable references. Most alignment strategies continue to reference the bone despite the complexity in anatomical variations and presence of deformity. Categorical prescription of a singular alignment philosophy for all patients may not be appropriate. This study aims to characterize coronal alignment correctability in relation to anatomical measures to develop a mechanism for distinguishing patients for whom repeatable strategies are optimal in the form of alternative alignment techniques or advanced soft tissue balancing. METHODS: A consecutive series of 103 pre-operative knees who underwent primary total knee arthroplasty (TKA) were analysed. Pre-operative supine computer tomography (CT) scans were segmented, with output STL bone models placed against several stressed positions determined by the TELOS SD-900 (METAX, Germany) device. Anatomical analysis using two-dimensional (2D) -3D image registration was performed. Statistical analysis was conducted for variations in anatomical morphology and regression modelling was used to determine the relationship between these measurements and correctability of a patient. RESULTS: The mean preoperative supine hip-knee-ankle (HKA) angle was 5.1° and 2.3°, lateral distal femoral angle (LDFA) was 2.0° and 3.1°, medial proximal tibial angle (MPTA) was 3.7° and 3.0° varus for male and female, respectively. The mean laxity range was 4.3°. We found 36% of valgus patients and 55% of mild varus patients to be correctable. Supine HKA was a statistically significant predictor for correctability (P < 0.001). A statistically significant correlation between laxity and the HKA (P = 0.01) as well as LDFA angles (P = 0.01) exist for the mild varus cohort. CONCLUSION: Relationship between HKA angle and the correctability of the knee joint to neutral in patients presenting with mild to moderate varus cannot be consistently predicted using bony anatomy. If there is a desire to avoid ligament release during TKA, careful consideration of both a patient's bony anatomy and soft tissue laxity envelope must be made prior to surgery.

Minimal important change and minimum clinically important difference values of the KOOS-12 after total knee arthroplasty.

PURPOSE: The minimal important change (minimal amount of change vs. baseline that a patient recognizes as a clinical change) and minimum clinically important difference (smallest difference between two measurements that are deemed important by patients) are important values to evaluate the clinical relevance of changes over time and differences between groups. This study aims to establish these values for the KOOS-12 at 1 year postoperatively. METHODS: KOOS-12 scores were calculated from the full-length KOOS completed by patients undergoing primary TKA preoperatively and at 1 year follow up. Minimal important change (MIC) values were estimated using the anchor-based predictive modeling approach and adjustment for the large proportion of improved patients in the study cohort was performed. The MCID was defined as the difference in the mean change in the KOOS-12 between the 'no improvement' and 'little improvement' groups. RESULTS: A total of 352 patients (161 male:191 female) with an overall mean age of 67.9 years (standard deviation (SD) 8.2) and a mean body mass index of 31.4 kg/m2 (SD 6.3) were included: 97.1% of patients reported an important improvement, 1.1% reported being about the same and 1.7% reported being importantly worse. The MIC improvement values were 11.5 for Pain, 13.7 for Function, 5.5 for Quality of Life (QoL) and 14.9 for the total KOOS-12 score. MCID values were 13.5 for Pain, 15.2 for Function, 8.0 for QoL and 11.1 for the total KOOS-12 score. CONCLUSION: MIC of 14.9 and MCID of 11.1 established in this study can assist clinicians and researchers in the interpretation of within-group changes (MIC) and differences between groups (MCID) at 1 year after TKA.

The ceiling effects of patient reported outcome measures for total knee arthroplasty.

BACKGROUND: Patient reported outcome measurements (PROMs) that exhibit a substantial ceiling effect show clustering of participant's scores towards the upper limit of a scale and consequently have low discriminatory power among high end scores. This study aimed to compare ceiling effects at 1 and 2 years postoperatively across commonly usedPROMs for TKA. HYPOTHESIS: We hypothesized, that the analyzed PROMs differ substantially in regards to their ceiling effect. PATIENTS AND METHODS: Patients that underwent a primary unilateral TKA and completed pre-operative and post-operative questionnaires were included in the analysis. Participants completed the KOOS, KOOS-12, KOOS-JR, KOOS-PS, WOMAC and OKS preoperatively, and completed the KOOS, KOOS-12, KOOS-JR, KOOS-PS, WOMAC,OKS and FJS postoperatively at 1 and 2 years. RESULTS: 1-year and 2-year follow-up data was available for 380 and 193 patients, respectively. The preoperative mean age was 68.0 (8.5) and mean BMI was 31.4kg/m2 (6.6), with a male to female ratio of 49.6% to 50.4%. At 1 year postoperatively, a ceiling effect was seen for the Pain and ADL subscales of the KOOS and the KOOS JR. The KOOS Pain, Symptoms, ADL and QoL subscales, the WOMAC Total and KOOS JR exhibited a ceiling effect at 2 years postoperatively. We found 9.0% and 14.8% of patients achieving a maximum score in the FJS at 1 and 2 years, respectively, indicating the absence of a substantial ceiling effect. CONCLUSION: The PROMs studied differ substantially with regards to their ceiling effect and consequently their ability to detect differences between well performing groups. The KOOS Pain, Symptoms, ADL and QoL subscales, the WOMAC Total and KOOS JR exhibited a substantial ceiling effect at 2 years postoperatively. We recommend using PROMs like the FJS and KOOS-12 with a more evenly distribution of scores across the scale when studying well performing cohorts. LEVEL OF EVIDENCE: III.

The KOOS-12 shortform shows no ceiling effect, good responsiveness and construct validity compared to standard outcome measures after total knee arthroplasty.

PURPOSE: To investigate the validity, responsiveness and ceiling effect of the recently introduced KOOS-12 and compare its performance to the KOOS, OKS, WOMAC and UCLA activity scales. METHODS: Patients from an independent multicentre study examining a medially stabilized knee system prospectively completed the KOOS, OKS, WOMAC and UCLA preoperatively and at 1 year postoperatively. KOOS-12 scores were calculated from the full length KOOS data. Construct validity was assessed using Spearman's correlation analysis. The ceiling effect was evaluated by calculating the percentage of patients with a maximum score. If the percentage exceeded 15%, a ceiling effect was considered to be present. Responsiveness was evaluated by performing paired t tests on the changes in measures and calculation of Cohen's d. RESULTS: A ceiling effect was present for the KOOS Pain, ADL and QoL subscales and the KOOS-JR at 1 year postoperatively. No ceiling effect was observed for the KOOS-12. Correlation of the KOOS-12 was low (0.3 < r < 0.5) with the UCLA, moderate (0.5 < r < 0.7) with the KOOS symptoms, sports and WOMAC stiffness subscales and high (r > 0.7) with all other scores and subscales. Effect size of the UCLA activity scale was moderate (Cohen's d 0.2-0.8) whereas effect sizes of all other outcome measures were large (d > 0.8). CONCLUSION: The KOOS-12 does not exhibit a ceiling effect, has good convergent construct validity and is responsive to changes in pain, function, QoL and knee impact between preoperatively and 1 year postoperatively. LEVEL OF EVIDENCE: Diagnostic level III.

Does Prosthetic or Bony Impingement Occur More Often in Total Hip Arthroplasty: A Dynamic Preoperative Analysis.

BACKGROUND: Impingement is a leading cause for instability resulting in revision total hip arthroplasty (THA). Impingement can be prosthetic, bony, or soft tissue. The purpose of this study is to investigate, using a virtual simulation, whether bony or prosthetic impingement presents first in well-positioned THAs. METHODS: Twenty-three patients requiring THA were planned for a ceramic-on-poly cementless construct using dynamic planning software. Cups were orientated at 45° inclination and 25° anteversion when standing. Femoral components and neck lengths were positioned to reproduce native anteversion and match contralateral leg length and offset. The type and location of impingement was then recorded with recreation of anterior and posterior impingement during standard and extreme ranges of motion (ROM). RESULTS: In standard ROM, flexion produced both prosthetic and bony impingement and extension resulted in prosthetic impingement in models with lipped liners. In extreme ROM, anterior impingement was 78% bony in 32-mm articulations, and 88% bony in 36-mm articulations. Posterior impingement was 65% prosthetic in 32-mm articulations, and 55% prosthetic in 36-mm articulations. Dual mobility cups showed the greatest risk of posterior prosthetic impingement in hyperextension (74%). CONCLUSION: In standard ROM, both bony and prosthetic impingement occurred in flexion, while prosthetic impingement occurred in extension in models with lipped liners. In hyperextension, prosthetic impingement was more common than bony impingement, and was exclusively the cause of impingement when a lip was used. In flexion, impingement was primarily bony with the use of a 36-mm head. The risk of posterior prosthetic impingement was greatest with dual mobility cups. LEVEL OF EVIDENCE: 3.

Prevalence of Sagittal Spinal Deformity Among Patients Undergoing Total Hip Arthroplasty.

BACKGROUND: The important relationship between sagittal spinal alignment and total hip arthroplasty (THA) is becoming well recognized. Prior research has shown a significant relationship between sagittal spinal deformity (SSD) and THA instability. This study aims at determining the prevalence of SSD among preoperative THA patients. METHODS: A multicenter database of preoperative THA patients was analyzed. Radiographic parameters measured from standing radiographs included anterior pelvic plane tilt, spinopelvic tilt, and lumbar lordosis (LL); pelvic incidence (PI) was measured from computed tomography scans. Lumbar flatback was defined as PI-LL mismatch >10°, balanced as PI-LL of -10° to 10°, and hyperlordosis as PI-LL <-10°. RESULTS: A total of 1088 patients were analyzed (mean, 64 years; 48% female). And 59% (n = 644) of patients had balanced alignment, 16% (n = 174) had a PI-LL > 10°, and 4% (n = 46) had a PI-LL > 20° (severe flatback deformity). The prevalence of hyperlordosis was 25% (n = 270). Flatback patients tended to be older than balanced and hyperlordotic patients (69.5 vs 64.0 vs 60.8 years, P < .001). Spinopelvic tilt was more posterior in flatback compared to balanced and hyperlordotic patients (24.7° vs 15.4° vs 7.0°) as was anterior pelvic plane tilt (-7.1° vs -2.0° vs 2.5°) and PI (64.1° vs 56.8° vs 49.0°), all P < .001. CONCLUSION: Only 59% of patients undergoing THA have normally aligned lumbar spines. Flatback SSD was observed in 16% (4% with severe flatback deformity) and there was a 25% prevalence of hyperlordosis. Lumbar flatback was associated with increasing age, posterior pelvic tilt, and larger PI. The relatively high prevalence of spinal deformity in this population reinforces the importance of considering spinopelvic alignment in THA planning and risk stratification.

Variation in femoral anteversion in patients requiring total hip replacement.

BACKGROUND: Optimal implant alignment is important for total hip replacement (THR) longevity. Femoral stem anteversion is influenced by the native femoral anteversion. Knowing a patient's femoral morphology is therefore important when planning optimal THR alignment. We investigated variation in femoral anteversion across a patient population requiring THR. METHODS: Preoperatively, native femoral neck anteversion was measured from 3-dimensional CT reconstructions in 1215 patients. RESULTS: The median femoral anteversion was 14.4° (-27.1-54.5°, IQR 7.4-20.9°). There were significant gender differences (males 12.7°, females 16.0°; p < 0.0001). Femoral anteversion in males decreased significantly with increasing age. 14% of patients had extreme anteversion (<0° or >30°). CONCLUSIONS: This is the largest series investigating native femoral anteversion in a THR population. Patient variation was large and was similar to published findings of a non-THR population. Gender and age-related differences were observed. Native femoral anteversion is patient-specific and should be considered when planning THR.

A Preoperative Analytical Model for Patient-Specific Impingement Analysis in Total Hip Arthroplasty.

Prosthetic impingement is important to consider during total hip arthroplasty planning to minimise the risk of joint instability. Modelling impingement preoperatively can assist in defining the required component alignment for each individual. We developed an analytical impingement model utilising a combination of mathematical calculations and an automated computational simulation to determine the risk of prosthetic impingement. The model assesses cup inclination and anteversion angles that are associated with prosthetic impingement using patient-specific inputs, such as stem anteversion, planned implant types, and target Range of Motion (ROM). The analysed results are presented as a range of cup inclination and anteversion angles over which a colour map indicates an impingement-free safe zone in green and impingement risk zones in red. A validation of the model demonstrates accuracy within +/- 1.4° of cup inclination and anteversion. The study further investigated the impact of changes in stem anteversion, femoral head size, and head offset on prosthetic impingement, as an example of the application of the model.

Effects of Sagittal Spinal Alignment on Postural Pelvic Mobility in Total Hip Arthroplasty Candidates.

BACKGROUND: Recent research has demonstrated that patients with reduced pelvic mobility from standing to sitting have higher rates of dislocation after total hip arthroplasty (THA). This study evaluates the effect of sagittal spinal deformity, defined by pelvic incidence-lumbar lordosis mismatch (PI-LL), on postural changes in pelvic tilt (PT). METHODS: A multicenter database of 1100 preoperative THA patients was queried. Anterior-pelvic-plane tilt (APPt), spinopelvic tilt (SPT), and LL were measured from radiographs of patients in supine, standing, flexed-seated, and stepping-up postures; PI was measured from computed tomography. Patients were separated into 3 groups based on PI-LL (<-10°, -10° to 10°, >10°) and propensity-score matched by PI. Lumbar flatback-deformity was defined as PI-LL > 10°, hyperlordosis: PI-LL < -10°. SPT/APPt, including changes between each posture were compared across PI-LL groups using analysis of variance, with post-hoc Tukey tests. Pearson correlations were reported when testing associations between SPT/APPt change and PI-LL. RESULTS: After propensity-score matching, 288 patients were analyzed (mean 65 y; 49% F). SPT and APPt change differed across all PI-LL categories from standing to seated, supine, and stepping-up with less SPT/APPt recruitment among hyperlordotic vs flatback patients (all P < .001). Greater PI-LL correlated with greater SPT recruitment from standing to seated (R = 0.294), supine (R = 0.292), and stepping-up (R = 0.207) (all P < .001). Smaller LL changes from standing to seated were associated with greater SPT recruitment (R = 0.372, P < .001). CONCLUSIONS: Postural changes in SPT/APPt are associated with spinopelvic measures in THA candidates. Hyperlordotic patients tend to utilize their spines more compared with flatback patients who were more likely to recruit PT. Increased focus on patients with lumbar flatback and hyperlordosis may help in reducing prosthetic dislocation prevalence following THA.

Prevalence of Anterior Femoral Neck Osteophyte in a Total Hip Arthroplasty Population: Analysis of Preoperative Surgical Plans.

Despite strongly positive results of total hip arthroplasty (THA), patients remain at risk for complications including dislocation. Spinopelvic motion and the hip-spine relationship have been recognized as important factors in surgical planning and implant positioning in THA. Periarticular osteophytes are one of the hallmark pathoanatomic features of osteoarthritis and may influence implant positioning and joint stability; residual osteophytes at the anterior femoral neck may cause anterior impingement and posterior instability. No studies have been identified which establish the prevalence of anterior femoral neck osteophyte for incorporation into THA planning. 413 consecutive patients scheduled for THA underwent preoperative planning taking into account spinopelvic motion to establish optimal component position. Each surgical plan was reviewed retrospectively by four independent raters who were blinded to other imaging and intraoperative findings. Anterior femoral neck osteophytes were rated as being absent, minor, or extensive for each case. A single outlying rater was excluded. Inter-rater reliability was calculated manually. The patient group comprised 197 male and 216 female hips, with a mean age of 63 years (range 32-91). The presence of anterior femoral neck osteophytes was identified in a mean of 82% of cases (range 78-86%). A significant number of patients were found to have large or extensive osteophytes present in this location (mean 27%; range 23-31%). Inter-rater reliability was 70%. A large majority of our THA patients were found to have anterior femoral neck osteophytes. These must be considered during preoperative planning with respect to the spinopelvic relationship. Failure to identify and address osteophytes intraoperatively may increase the risk of impingement in flexion and/or internal rotation, leading to decreased range of motion, joint instability, and possibly dislocation. Planned future directions include incorporation of an impingement and instability model into preoperative planning for THA.

International challenge to model the long-range transport of radioxenon released from medical isotope production to six Comprehensive Nuclear-Test-Ban Treaty monitoring stations.

After performing a first multi-model exercise in 2015 a comprehensive and technically more demanding atmospheric transport modelling challenge was organized in 2016. Release data were provided by the Australian Nuclear Science and Technology Organization radiopharmaceutical facility in Sydney (Australia) for a one month period. Measured samples for the same time frame were gathered from six International Monitoring System stations in the Southern Hemisphere with distances to the source ranging between 680 (Melbourne) and about 17,000 km (Tristan da Cunha). Participants were prompted to work with unit emissions in pre-defined emission intervals (daily, half-daily, 3-hourly and hourly emission segment lengths) and in order to perform a blind test actual emission values were not provided to them. Despite the quite different settings of the two atmospheric transport modelling challenges there is common evidence that for long-range atmospheric transport using temporally highly resolved emissions and highly space-resolved meteorological input fields has no significant advantage compared to using lower resolved ones. As well an uncertainty of up to 20% in the daily stack emission data turns out to be acceptable for the purpose of a study like this. Model performance at individual stations is quite diverse depending largely on successfully capturing boundary layer processes. No single model-meteorology combination performs best for all stations. Moreover, the stations statistics do not depend on the distance between the source and the individual stations. Finally, it became more evident how future exercises need to be designed. Set-up parameters like the meteorological driver or the output grid resolution should be pre-scribed in order to enhance diversity as well as comparability among model runs.

Setting the baseline for estimated background observations at IMS systems of four radioxenon isotopes in 2014.

Worldwide monitoring of radionuclides is an essential part of the verification system of the Comprehensive Nuclear-Test-Ban Treaty (CTBT) as it can provide a direct evidence of the nuclear nature of an explosion. In the case of underground nuclear testing, the radioactive noble gases, specifically radioxenon, have the highest probability to escape to the atmosphere. The detection capability of the CTBT noble gas network, which is being built, is weakened due to the presence of a worldwide civilian radioxenon background. Improving the understanding and knowledge of civilian radioxenon sources and their impact on the noble gas systems background is crucial to strengthen their verification capabilities. Two major civilian radioxenon sources have been identified in past research, namely: Medical Isotope Production Facilities (MIPFs) and Nuclear Power Plants (NPPs). In this study, a 2014 baseline radioxenon emission inventory is proposed for all four CTBT relevant radioxenon isotopes (Xe-131m, Xe-133m, Xe-133 and Xe-135) on the basis of a literature review for both the Medical Isotopes Productions Facilities and Nuclear Power Plants. This 2014 baseline radioxenon emission inventory relies on peer-reviewed information on the facility location and corresponding radioxenon emission. The baseline radioxenon emission inventory is used along with Atmospheric Transport Modelling (ATM) to estimate the radioxenon activity concentrations at the noble gas systems. The results reveal the complexity and the geographical dependence of the civilian radioxenon background. The estimations are compared to the observations for CTBT noble gas systems that were operational in 2014. It is demonstrated that the estimated Xe-133 activity concentrations are, for most systems, in the same order of magnitude than observed detections. Non-detections of Xe-131m, Xe-133m, Xe-133 and Xe-135 are, for most samples, well reproduced by the estimation. To our best knowledge, this study is the first attempt to propose, a baseline emission inventory for all four CTBT relevant radioxenon isotopes and compare the estimated Xe-131m, Xe-133m, Xe-133 and Xe-135 activity concentrations with all observations at CTBT noble gas systems during the full 2014 calendar year.

Calibration with MCNP of NaI detector for the determination of natural radioactivity levels in the field.

In view of assessing natural radioactivity with on-site quantitative gamma spectrometry, efficiency calibration of NaI(Tl) detectors is investigated. A calibration based on Monte Carlo simulation of detector response is proposed, to render reliable quantitative analysis practicable in field campaigns. The method is developed with reference to contact geometry, in which measurements are taken placing the NaI(Tl) probe directly against the solid source to be analyzed. The Monte Carlo code used for the simulations was MCNP. Experimental verification of the calibration goodness is obtained by comparison with appropriate standards, as reported. On-site measurements yield a quick quantitative assessment of natural radioactivity levels present ((40)K, (238)U and (232)Th). On-site gamma spectrometry can prove particularly useful insofar as it provides information on materials from which samples cannot be taken.