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ObjectivesThe comparative clinical effectiveness of common surgical techniques to address long head of biceps (LHB) pathology is unclear. We synthesised the evidence to compare the clinical effectiveness of tenotomy versus tenodesis.DesignA systematic review and meta-analysis using the Grading of Recommendations Assessment, Development and Evaluation approach.Data sourcesEMBASE, Medline, PsycINFO and the Cochrane Library of randomised controlled trials were searched through 31 October 2021.Eligibility criteriaWe included randomised controlled trials, reporting patient reported outcome measures, comparing LHB tenotomy with tenodesis for LHB pathology, with or without concomitant rotator cuff pathology. Studies including patients treated for superior labral anterior–posterior tears were excluded. No language limits were employed. All publications from database inception to 31 October 2021 were included.Data extraction and synthesisScreening was performed by two authors independently. A third author reviewed the article, where consensus for inclusion was required. Data were extracted by two authors. Data were synthesised using RevMan. Inverse variance statistics and a random effects model were used.Results860 patients from 11 RCTs (426 tenotomy vs 434 tenodesis) were included. Pooled analysis of patient-reported functional outcome measures data demonstrated comparable outcomes (n=10 studies; 403 tenotomy vs 416 tenodesis; standardised mean difference (SMD): 0.14, 95% CI −0.04 to 0.32, p=0.13). There was no significant difference for pain (Visual Analogue Scale) (n=8 studies; 345 tenotomy vs 350 tenodesis; MD: −0.11, 95% CI −0.28 to 0.06, p=0.21). Tenodesis resulted in a lower rate of Popeye deformity (n=10 studies; 401 tenotomy vs 410 tenodesis; OR: 0.29, 95% CI 0.19 to 0.45, p<0.00001). Tenotomy demonstrated shorter operative time (n=4 studies; 204 tenotomy vs 201 tenodesis; MD 15.2, 95% CI 1.06 to 29.36, p<0.00001).ConclusionsAside from a lower rate of cosmetic deformity, tenodesis yielded no significant clinical benefit to tenotomy for addressing LHB pathology.PROSPERO registration numberCRD42020198658.

ObjectivesImplementing support and services early in the life course has been shown to promote positive developmental outcomes for children at high likelihood of developmental conditions including autism. This study examined parents’/caregivers’ experiences and perceptions about a digital developmental surveillance pathway for autism, the autism surveillance pathway (ASP), and usual care, the surveillance as usual (SaU) pathway, in the primary healthcare general practice setting.DesignThis qualitative study involves using a convenience selection process of the full sample of parents/caregivers that participated in the main programme, ‘General Practice Surveillance for Autism’, a cluster-randomised controlled trial study. All interviews were audio-recorded, transcribed and coded using NVivo V.12 software. An inductive thematic interpretive approach was adopted and data were analysed thematically.ParticipantsTwelve parents/caregivers of children with or without a developmental condition/autism (who participated in the main programme) in South Western Sydney and Melbourne were interviewed.SettingsAll interviews were completed over the phone.ResultsThere were seven major themes and 20 subthemes that included positive experiences, such as pre-existing patient–doctor relationships and their perceptions on the importance of knowing and accessing early support/services. Barriers or challenges experienced while using the SaU pathway included long waiting periods, poor communication and lack of action plans, complexity associated with navigating the healthcare system and lack of understanding by general practitioners (GPs). Common suggestions for improvement included greater awareness/education for parents/carers and the availability of accessible resources on child development for parents/caregivers.ConclusionThe findings support the use of digital screening tools for developmental surveillance, including for autism, using opportunistic contacts in the general practice setting.Trial registration numberANZCTR (ACTRN12619001200178).

Background Significant challenges remain in the early identification of child developmental disabilities in the community. Implementing supports and services early in the life course has been shown to promote positive developmental outcomes for children at high likelihood of developmental disabilities, including autism. As part of a cluster randomised controlled trial, this study seeks to examine and compare the perspectives and experiences of Australian general practitioners (GPs) in relation to a digital developmental surveillance program for autism and usual care pathway, in general practice clinics. Methods A qualitative research methodology with semi-structured interviews and thematic inductive analysis underpinned by grounded theory was utilised. All GPs from South Western Sydney (NSW) and Melbourne (Victoria) who participated in the main program (“GP Surveillance for Autism”) were invited to the interview. GPs who provided consent were interviewed either over online or in-person meeting. Interviews were audio-recorded, transcribed, and coded using NVivo12 software. Inductive interpretive approach was adopted and data were analysed thematically. Results Twenty-three GPs across the two sites (NSW: n = 11; Victoria: n = 12) agreed to be interviewed; data saturation had reached following this number of participants. Inductive thematic coding and analysis yielded eight major themes and highlighted common enablers such as the role of GPs in early identification and subsequent supports, enhanced communication between clinicians/professionals, relationship-building with patients, and having standardised screening tools. Specific facilitators to the feasibility and acceptability of a digital screening program for the early identification of developmental disabilities, including the early signs of autism, and encouraging research and education for GPs. However, several practical and socioeconomic barriers were identified, in addition to limited knowledge and uptake of child developmental screening tools as well as COVID-19 lockdown impacts. Common and specific recommendations involve supporting GPs in developmental/paediatrics training, streamlined screening process, and funding and resources in the primary healthcare services. Conclusions The study highlighted the need for practice and policy changes, including further training of GPs alongside sufficient time to complete developmental checks and appropriate financial remuneration through a Medicare billing item. Further research is needed on implementation and scale up of a national surveillance program for early identification of developmental disabilities, including autism.

This study examined connections between parental quality of life (QoL) and features of children (autism severity, cognitive ability, behavioral profile, and sociodemographic factors). Parents of 97 children attending an autism-specific preschool completed the Quality of Life in Autism, Vineland Adaptive Behavior Scales and Child Behavior Checklist. The Autism Diagnostic Observation Schedule and Mullen Scales of Early Learning were also administered. Reduced restrictive/repetitive behavior and higher socialization and play/leisure scores were associated with better parental QoL. Better behavioral regulation and attention also predicted better QoL, as did stronger communication and reduced internalising behaviours. Findings indicate that a child’s level of autism specific traits, adaptive functioning and behavioral profile has greater impact on parental QoL than cognitive level.

Sedimentary pyrite (FeS2) formation is a major sink in the terrestrial and oceanic sulfur cycle, and its burial is interlinked with modern carbon and iron cycling as well as the oxidation of the atmosphere and oceans on Earth. However, the formation pathways of sedimentary pyrite in the environment are still debated and yet to be elucidated. Pyrite formation is generally thought to proceed from microbial sulfate reduction driven by the presence of organic carbon, which results in the production of H2S (S in the S2- oxidation state), the most reduced form of sulfur. H2S interacts with iron minerals in the environment to precipitate pyrite, where the average oxidation state of S is -1. This indicates that for pyrite to form, either more oxidized forms of sulfur will need to react with reduced iron, or a precursor iron monosulfide mineral, which forms from the interactions between reduced iron and hydrogen sulfide, will need to be oxidized. The pathways of pyrite formation have been extensively studied previously in the laboratory, but due to the cryptic nature of the sulfur cycle, which involves several intermediate redox state sulfur species, it has been difficult to clarify the exact mechanisms in which pyrite precipitates within sediments. Since pyrite formation is limited by the presence and abundance of reactive iron minerals in the environment, observing the behavior of S species in an iron-rich environment could reveal detailed formation mechanisms. To address this, we studied the redox stratified water column and sediments of meromictic and ferruginous Brownie Lake in Minneapolis, Minnesota, USA. The ferruginous nature of Brownie Lake provides the opportunity to directly observe the S intermediates and precursor iron monosulfides that are involved in pyrite formation in a natural environment, since most of the mechanisms of pyrite formation so far have been established via laboratory incubations. We approached this study by investigating the Fe and S speciation and abundances in Brownie Lake water column and bottom sediments using voltammetry, Mössbauer spectroscopy, synchrotron-based X-ray absorption spectroscopy (XAS) and X-ray fluorescence (XRF). Water column and bottom sediments of Brownie Lake showed aqueous nanoparticulate, as well as solid FeS pyrite precursors. Additionally, the presence of Fe(III)oxyhydroxides and elemental S in the water column suggests that pyrite formation initiates with the sulfidation of Fe(III)oxyhydroxides coupled with FeS dissolution via polysulfides. Brownie Lake sediments hosted pyrite with increasing abundance downcore, and the variations in the abundance of elemental S down the sediment column suggests that pyrite could be forming via the sulfidation of Fe(III)oxyhydroxides in shallow sediments where H2S is produced, which then gets consumed in deeper sediments by the FeS to form pyrite. Our study therefore reveals the transformation of sulfur species in sedimentary pyrite formation in the iron-rich water column and sediments of Brownie Lake.

A smart grid system is one of the most complex cyber-physical systems consisting of power generation, distribution, consumption, customer domains, and millions of connected end devices. The widespread implementation of the smart grid raises concerns about the privacy of the data it collects. Users fear that their sensitive and private data will get leaked in the process of data collection or transmission which is a significant roadblock towards smart grid development. Hence, there is an urgent need to provide the user with a privacy solution to support selective sharing of their usage data with different entities. In this paper, we propose an ontology-based user privacy management approach that will enable the user to release their data based on sensitivity and privacy factors, thus making an informed privacy decision on their usage data sharing. Green Button Initiative is a smart grid application that allows users to download and share their energy usage data with third parties. We presented a proof-of-concept implementation extending the Green Button Initiative to test the feasibility of the proposed approach. Lastly, we conducted a comparative user study to investigate the effectiveness of our proposed approach.

PurposeA number of classification systems exist for posterior malleolar ankle fractures. The user reliability of these classification systems remains unclear. The primary aim of this study was to evaluate the reliability of three commonly utilised classification systems for fractures of the posterior malleolus. MethodsImaging of 60 patients across 2 hospitals with ankle fractures including a posterior malleolar fragment was identified. All patients had undergone plain radiographs and computed tomography of their injured ankle as part of their normal standard of care. 9 surgeons including pre-resident/registrar level, resident/registrar level, and attending/consultant level applied the Haraguchi, Bartoníček, and Mason classifications to these fractures, at two timepoints, at least 4 weeks apart. The order was randomised between assessments. Inter-rater reliability was assessed using Fleiss’ κ and standard error (SE). Intra-rater reliability was assessed using Cohen’s κ and standard error (SE).ResultsInter-rater reliability (Fleiss’ κ) was calculated for the Haraguchi classification as 0.588 (SE 0.023), for the Bartoníček classification as 0.626 (SE 0.019), and the Mason classification as 0.541 (SE 0.098). Intra-rater reliability (Cohen’s κ) was 0.761 (SE 0.098) for the Haraguchi classification, 0.761 (SE 0.091) for the Bartoníček, classification, and 0.724 (SE 0.096) for the Mason classification.ConclusionsThis study reports the inter-rater and intra-rater reliability for three classification systems for posterior malleolus fractures. Based on definitions by Landis and Koch (Biometrics 33:159-174, 1977), inter-rater reliability was rated as ‘moderate’ for the Haraguchi and Mason classifications and ‘substantial’ for the Bartoníček classification. Similarly, the intra-rater reliability was rated as ‘substantial’ for all three classifications.

In supervised machine learning, feature selection plays a very important role by potentially enhancing explainability and performance as measured by computing time and accuracy-related metrics. In this paper, we investigate a method for feature selection based on the well-known L1 and L2 regularization strategies associated with logistic regression (LR). It is well known that the learned coefficients, which serve as weights, can be used to rank the features. Our approach is to synthesize the findings of L1 and L2 regularization. For our experiment, we chose the CIC-IDS2018 dataset owing partly to its size and also to the existence of two problematic classes that are hard to separate. We report first with the exclusion of one of them and then with its inclusion. We ranked features first with L1 and then with L2, and then compared logistic regression with L1 (LR+L1) against that with L2 (LR+L2) by varying the sizes of the feature sets for each of the two rankings. We found no significant difference in accuracy between the two methods once the feature set is selected. We chose a synthesis, i.e., only those features that were present in both the sets obtained from L1 and that from L2, and experimented with it on more complex models like Decision Tree and Random Forest and observed that the accuracy was very close in spite of the small size of the feature set. Additionally, we also report on the standard metrics: accuracy, precision, recall, and f1-score.

Recent extended summer seasons have presented considerable challenges for mushroom cultivation, underscoring the need for summer-adapted commercial varieties like C alocybe indica . The casing is essential for its cultivation, which conventionally employs loamy soil (LS). However, given the non-renewable nature of LS and the environmental concerns associated with spent mushroom substrate (SMS), our study explored SMS as a potential alternative. We analyzed the physio-chemical properties and microbial flora, especially bacterial composition, using MALDI-TOF in both LS and SMS. The total yield, biological efficiency, and mineral content of mushrooms grown on these substrates. While most of the physio-chemical properties of SMS align with the ideal casing properties, it exhibits higher electrical conductivity (EC) and a greater C/N ratio. The dominating bacterial flora in SMS, including Bacillus , Priestia , and Lysinbacillus , contribute to the mushrooms’ temperature tolerance and facilitate nutrient uptake, especially phosphorous (P). The yields and biological efficiency were significantly higher in LS, likely due to its superior mechanical support. Furthermore, the findings indicated that the qualities of element levels, particularly copper (Cu), zinc (Zn), and phosphorous (P), were markedly elevated in mushrooms grown on SMS, except for iron (Fe). The PCA biplot results further supported these findings. The significantly elevated phosphorus (P) level in mushrooms grown in SMS highlights the role of phosphorous-solubilizing bacteria in SMS. Interestingly, Calocybe indica consistently exhibited higher iron (Fe) content than Pleurotus ostreatus , irrespective of the casing material used. The metal bioaccumulation factors (BCF) reveal that Calocybe indica is a hyperaccumulator of potassium (K) but does not bioaccumulate manganese (Mn). It also showed a low accumulation level of calcium (Ca) and iron (Fe), suggesting a synergistic interaction between Ca and Fe. In conclusion, LS proved more effective in maximizing yield, while SMS emerged as a sustainable alternative, enhancing the nutritional content of mushrooms and presenting a feasible choice for ecologically aware farming.