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Arthroscopic management of labral tears in femoroacetabolar impingement: current concepts.
No full textSurgical intervention for labral lesions associated with femoroacetabular impingement (FAI) has evolved significantly over the past two decades. The earliest surgical approaches include labral debridement and labral repair. More recently, the concept of labral reconstruction has gained popularity. Despite these advancements, a consensus regarding the optimal surgical approach remains elusive. The present systematic review updates the current evidence on the arthroscopic management of labral ailments in patients with symptomatic FAI. This systematic review adhered to the PRISMA statement. The Web of Science, PubMed, and Embase databases were accessed in July 2025. All clinical investigations comparing two different labral management methods for FAI were included. Data from 23,222 patients were retrieved. Of them, 54.6 % (12,683 of 23,222 patients) were women. The mean follow-up duration was 33.0 ± 19.4 months. The mean age was 35.0 ± 6.3 years, and the mean BMI was 25.1 ± 1.3 kg/m . The current evidence on arthroscopic management of labral tears in femoroacetabular impingement is limited and heterogeneous. Available data suggest potential advantages of labral preservation and reconstruction over debridement, but these findings cannot be considered definitive. At present, no strong clinical recommendations can be made. Further randomized controlled trials with long-term follow-up are required to clarify the optimal surgical strategy. [Abstract copyright: © 2025 The Authors.
Neural immune cell responses to electrospun polymer nanofibres: microglial dynamics and territoriality
Full text linkTraumatic central nervous system (CNS) injury can induce dramatic, permanent, functional deficits, often necessitating life-long care for typically young patients [especially spinal cord injury (SCI)]. Treatment is palliative, hopefully limiting secondary damage and maximising remaining function, but without promoting repair. Developing regenerative treatments could restore function. Evidence suggests that implanted biomaterial scaffolds can enhance spinal cord repair. Polymer nanofibres may have particular therapeutic value, as testing demonstrates guidance of nerve re-growth across lesions, and other regenerative responses. However, there is limited assessment of neural immune cell responses to nanofibres. How microglia (principle CNS immune cells) respond will be critical at an implant site, as toxicity, inflammatory or degradative responses could exacerbate injury, and/or hinder repair. In vitro screening systems are required to document microglia-nanofibre interactions.Here, electrospinning protocols were developed to generate fibres from a clinically approved polymer (polycaprolactone, PCL), collected on windowed frames (e.g. O-rings) on a rotating mandrel, with biocompatibility of various reagents established. Scaffold characterisation showed a high degree of alignment (many parallel fibres, desirable for CNS repair) and consistent, narrow diameter (625 ± 89 nm). Microglia (primary mouse cortex), seeded on scaffolds, were analysed by light, fluorescence, time-lapse and scanning electron microscopy (SEM), confirming their viability and adherence to fibres. Morphological analysis by fluorescence microscopy was possible, but iii challenging, due to fibre autofluorescence. SEM demonstrated bipolar fibre-adherent microglia, revealing membrane features (e.g. filopodia). Timelapse imaging of microglia on fibres is reported for the first time, and novel analyses of microglial behaviours are reported [e.g. rates of movement (avg: 0.52 ± 0.20 µm/min), distances travelled, territoriality, etc]. Interestingly, microglia rarely crossed other microglia while on individual fibres, reversing when meeting. Behaviours were compared with microglia in 2D-glass and 3D-hydrogel (collagen) cultures. These scaffold production techniques and behavioural analyses offer insights and tools for screening neural responses to neuro-regenerative implantable fibres
The S B 9 catalogue: status, comparison with non-single stars from Gaia DR3, and evolution to S B X
No full textThe Ninth Catalogue of Spectroscopic Binary Orbits (S) is a comprehensive compilation of spectroscopic binaries (SBs) with orbital parameters sourced from the literature, comprising approximately 4000 systems with about 2800 single-lined and 1200 double-lined binaries. This work presents the latest status of the S catalogue after over two decades of development since its online inception in 2004. In particular, we expose the statistical properties of SBs in terms of orbital period distributions and eccentricity–period diagrams per spectral type and evolutionary stage. We perform a careful cross-match with the Gaia Data Release 3 (DR3) to update astrometric parameters and compare with the Gaia DR3 non-single star (NSS) catalogue. Our cross-matching approach uses positional separations, magnitudes, and proper-motion back-propagation to identify counterparts. The final S version updated by D. Pourbaix (2021-03-02) includes 4003 SB systems, some in higher order multiples: 152 in triples, 71 in quadruples, and 14 in higher order systems. Among these 4003 SB, 3976 have matching Gaia DR3 identifiers, while 21 are too bright and six too faint for Gaia detection. 10 red S systems with periods larger than 1180 d (including a spectroscopic triple) have been spatially resolved by Gaia DR3. We identify a common sample of 827 S binaries cross-matched with Gaia NSS, among which 655 are considered as reliable, based on relative period and absolute eccentricity differences not exceeding 10 per cent. The limited overlap (21 per cent of S) is primarily due to selection cuts in NSS SB1 analysis, brightness limits, temporal baselines, and partial orbital solutions in the Gaia NSS catalogue. This study highlights the strengths and limitations of both catalogues and establishes a clean benchmark sample for future binary star research. Our work marks the transition of S into S, The eXtended Catalogue of Spectroscopic Binary Orbits, featuring a modern relational data base, improved web interface, and Virtual Observatory access standards, aiming to enhance accessibility, data quality, and analysis capabilities for the binary and multiple star community
Trends and inequalities in advice and guidance versus direct referral in NHS primary care, 2015-23: population based study
Full text linkObjectives: To examine trends and variation in the use of advice and guidance compared with direct referrals in primary care, and to assess potential inequalities across population groups.Design: Population based study.Setting: Clinical Practice Research Datalink (CPRD) Aurum, an anonymised UK primary care database, 1 January 2015 to 31 December 2023.Participants: 16 340 696 patients with electronic health record data registered in CPRD; 671 894 (4% of the registered population) had advice and guidance recorded and 9 719 796 (59% of the registered population) had a direct referral recorded.Main outcome measures: Annual prevalence of advice and guidance, and direct referrals, in each calendar year, grouped by age, sex, social deprivation, locality, and ethnic group. Mapping of clinical codes to determine target specialities for advice and guidance. Proportion of individuals recorded with advice and guidance and a direct referral within ±4 months.Results: 16 340 696 registered patients were analysed between 2015 and 2023; 671 894 patients (4%) had advice and guidance recorded and 9.7 million (59%) had a direct referral. Use of advice and guidance increased 19-fold from 0.10% to 1.97% of the registered population, doubling between 2019 and 2020 during the covid-19 pandemic. Direct referral rates decreased from 23-25% before the pandemic to 18% in 2020, before recovering to 24% by 2023. Cardiology (21%), dermatology (7%) and ear, nose, and throat (5%) were the most common specialties linked to advice and guidance. Most patients receiving advice and guidance (86%) also had a direct referral within ±4 months. Inequities were evident: use of advice and guidance was higher among older, white, and less deprived patients, whereas minority ethnic and more deprived groups had slower recovery of direct referral rates after the pandemic.Conclusions: The study showed that the use of advice and guidance has increased substantially since 2015, accelerated by the covid-19 pandemic and maintained after, but has not displaced direct referrals. Direct referral often preceded advice and guidance, raising questions about efficiency and equity. Use of advice and guidance was higher among older, white, and less deprived individuals, whereas minority ethnic and more socially deprived groups were more likely to have direct referrals after advice and guidance, suggesting potential delays in access to specialist care. Policy should prioritise dealing with these inequalities and evaluate whether advice and guidance reduces unnecessary referrals or delays access to specialist care
Preliminary clinical evaluation in cross-sectional imaging: A qualitative exploration of current international radiography practice
No full textIntroductionImplementation and practice compliance of preliminary clinical evaluation (PCE) vary across national and international settings. The reason for these variations remains unclear, especially in relation to cross-sectional imaging. This study therefore explored PCE education and practice experiences of a multinational cohort of cross-sectional imaging radiographers with the aim of identifying effective training and implementation strategies, challenges, and opportunities for improvement.MethodsA phenomenological qualitative design was used, with purposive sampling to recruit a multinational cohort of cross-sectional imaging radiographers enrolled in a UK-based postgraduate medical imaging programme. Semi-structured, in-depth interviews were conducted via Microsoft Teams between December 2024 and February 2025. Data were analysed using Braun and Clarkes’ reflexive thematic analysis approach, facilitated by NVivo™ (v.20.0).ResultsTwelve radiographers from seven different countries participated in the study. The clinical experience of participants ranged (2–8 years), with most working in public or both public and private hospitals (8/12, 67 %) and (5/12, 42 %) had multinational clinical experience. All participants had PCE as a core component of their undergraduate training, but post-qualification practice expectations vary. Four overarching themes were developed: (1) education and skill refinement, (2) drivers for practice, (3) barriers to practice, and (4) opportunities for practice.ConclusionThe findings reveal inconsistencies in PCE education, including variable module content and teaching depth, which affect clinical preparedness and confidence. Additionally, systemic barriers and communication lapses hinder PCE integration, while engagement is driven by its perceived value for others, support for clinical decision-making and presence of PCE-specific practice frameworks.Implications for practiceStandardisation of PCE education and training, establishment of clear practice frameworks and addressing communication gaps can enhance the integration of PCE into routine clinical workflows
A critical analysis of far-right discourses about democratic memory in Spain: The Valley of the Fallen as a case study
Full text linkSince the emergence, in the dawn of the 21st century, of activist movements in Spain seeking to recuperate and restore the memory the victims of Franco’s dictatorship, there has been a strong backlash from the conservative sectors of the society with the intention to torpedo most of the legislative proposals and memory polices derived from this, creating a hostile environment against such projects as well as the agents promoting them. The ‘Valley of the Fallen’ is perhaps the most controversial of all Franco’s monuments: for many Spaniards, it represents the quintessence of Francoism. For the far-right, however, it is a sacred place located in a unique natural landscape and bestowed with an aura of artistic and religious worth and legitimacy. According to this view, its most noble purpose was to reconcile and honour the fallen of both sides of the war. For this reason, for both nostalgic old keepers of Francoism and new extreme right supporters, the Valley of the Fallen has become a pivotal political identity symbol. Within this mindset, any attempt to alter its nature, can be only understood as a totalitarian manipulation of the past and consequently as indoctrination. This thesis attempts to unravel, through a critical content and discourse analysis, the discursive strategies that the modern far-right has employed to shield this monument, partially grounded -although not solely- on old Francoist rhetorical elements. Particularly, it develops the concept of ‘discursive privilege’: a type of privilege, political by nature, that has served the far right to build up a rhetorical argumentative corpus up to date with the intention to keep the status quo born from the transitional period. It is that very status quo that the far right so tightly defends that justifies its unwillingness to come to terms with the past
Sociodemographic disparities in primary care management of back pain in children and young people: a population-based cohort study
Full text linkBackgroundResearch on the primary care management of back pain in children and young people (CYP) is scarce. Sociodemographic factors may influence presentation and management, potentially contributing to disparities in care and outcomes. This study aimed to describe the management of back pain in CYP and examine associations with sociodemographic characteristics.MethodsData were extracted from the Clinical Practice Research Datalink (CPRD) Aurum for 425,000 randomly sampled CYP aged 8–18 years with a new musculoskeletal pain episode between 2005 and 2021. Analgesia prescriptions, referrals and imaging within 6 months of an index consultation for back pain were extracted. Adjusted risk ratios (aRR) were calculated for age, gender, deprivation, ethnicity, region and index year.ResultsOf 51,335 CYP presenting with back pain, 78% had symptom-based codes for back pain or low back pain, and 12% had more specific diagnostic codes such as spinal deformities. 19% patients reconsulted for back pain in the 6 months following the index date. Analgesia was prescribed to 36% with higher prescribing rates among older CYP and those from more deprived areas (aRR most vs. least deprived 1.64; 95% CI 1.56, 1.72). Referrals (28%) and imaging (13%) were more common in older adolescents but less frequent among more deprived and minority ethnic groups. Prescribing declined over time (46% in 2005–2009 to 16% in 2020–2021), whereas referrals increased (17% to 40%).ConclusionsBack pain in CYP often recurs and is primarily managed with analgesia and referrals. Socioeconomic and ethnic disparities in management highlight the need for equitable access to specialist care and consistent, evidence-based approaches
Feeling the heat? metaverse as a platform for motivating pro-environmental behaviour through consumers’ climate (change) engagement
No full textThis study proposes to investigate how the metaverse experiences (usability, interactivity, personalization) influence their metaverse engagement. Further, this study also examines the influence of consumer climate (change) engagement dimensions on pro-environmental behaviour. A mixed-method approach was employed by collecting both qualitative and quantitative data to gain a comprehensive understanding of the conceptual framework. The findings of this study reveal that usability, interactivity and personalization are positively associated with consumer metaverse engagement. Further, consumer metaverse engagement is significantly associated with environmental knowledge and responsibility. Also, environmental knowledge and environmental responsibility are positively associated with pro-environmental behaviours. Finally, the results of this study reveal that climate change risk perception moderates the association between personalization and consumer metaverse engagement. The study is amongst the foremost research initiatives to examine the concept of consumer climate (change) engagement in the metaverse context. Further, this study enriches the metaverse and Uses and Gratification (U&G) theory literature. In doing so, it repositions U&G theory within the metaverse context and highlights its relevance for understanding consumer motivations and behaviours related to climate (change) engagement. Finally, this study provides several implications for brands, metaverse platforms, and other stakeholders interested in promoting pro-environmental behaviour within the metaverse
Everyone’s different: a qualitative study of patient perspectives on receiving information about methotrexate from rheumatology nurses
No full textObjectives Methotrexate is the anchor drug for rheumatoid arthritis (RA) but because of its risk/benefit profile needs careful education to ensure people take it safely. This study explores perspectives of people with RA receiving information provided by rheumatology nurses when starting Methotrexate, focusing on their needs, concerns and whether expectations matched their experiences. Methods Adults with RA participated in semi-structured qualitative interviews before and after receiving information when starting Methotrexate. Data was analysed using reflexive thematic analysis. Results Nineteen participants attending two rheumatology units in England shared their experiences of receiving information about Methotrexate treatment from a rheumatology nurse. An overarching theme described the desire to receive individualised care tailored to meet specific needs and concerns against experiences of standardised information. Many participants reported not having opportunities to discuss concerns about why they should take Methotrexate. Worries about side-effects and treatment-related harms were frequently unresolved. Recalling practical aspects of treatment, and timing of blood tests was often difficult. Knowing when Methotrexate should not be taken and acting on advice to seek medical help if unwell could be hard to understand. Lack of clarity about prescribing and monitoring added complexity and burden. Conclusion These findings provide insight into patient experiences, illustrating unmet information needs when starting Methotrexate to treat RA. People with RA wanted care to address their individual circumstances. A person-centred approach, providing tailored information addressing individual needs and concerns offers opportunities to increase patient satisfaction and information recall, leading to improved safety, treatment adherence and patient outcomes
