bluuebunny/crossref_metadata_2025 huggingface dataset:
Government Direct-to-Consumer Education to Reduce Prescription Opioid Use
Authors: Turner Justin P. , Halme Alex S. , Caetano Patricia , Langford Aili , Tannenbaum Cara
Published: May 2024

Importance

Direct-to-consumer education reduces chronic sedative use. The effectiveness of this approach for prescription opioids among patients with chronic noncancer pain remains untested.

Objectives

To evaluate the effectiveness of a government-led educational information brochure mailed to community-dwelling, long-term opioid consumers to reduce prescription opioid use compared with usual care.

Design, Setting, and Participants

This cluster randomized clinical trial was conducted from July 2018 to January 2019 in Manitoba, Canada. All adults with long-term opioid prescriptions were enrolled (n = 4225). Participants were identified via the Manitoba Drug Program Information Network. Individuals receiving palliative care or with a diagnosis of cancer or dementia were excluded. Data were analyzed from July 2019 to March 2020.

Intervention

Participants were clustered according to their primary care clinic and randomized to the intervention (a codesigned direct-to-consumer educational brochure sent by mail) or usual care (comparator group).

Main Outcomes and Measures

The main outcome was discontinuation of opioid prescriptions at the participant level after 6 months, ascertained by pharmacy drug claims. Secondary outcomes included dose reduction (in morphine milligram equivalents [MME]) and/or therapeutic switch. Reduction in opioid use was assessed using generalized estimating equations to account for clustering, with prespecified subgroup analyses by age and sex. Analysis was intention to treat.

Results

Of 4206 participants, 2409 (57.3%) were male; mean (SD) age was 60.0 (14.4) years. Mean (SD) baseline opioid use was comparable between groups (intervention, 157.7 [179.7] MME/d; control, 153.4 [181.8] MME/d). After 6 months, 235 of 2136 participants (11.0%) in 127 clusters in the intervention group no longer filled opioid prescriptions compared with 228 of 2070 (11.0%) in 124 clusters in the comparator group (difference, 0.0%; 95% CI, −1.9% to 1.9%). More participants in the intervention group than in the control group reduced their dose (1410 [66.0%] vs 1307 [63.1%]; difference, 2.8% [95% CI, 0.0%-5.7%]). Receipt of the brochure led to greater dose reductions for participants who were male (difference, 3.9%; 95% CI, 0.1%-7.7%), aged 18 to 64 years (difference, 3.7%; 95% CI, 0.2%-7.2%), or living in urban areas (difference, 5.9%; 95% CI, 1.9%-9.9%) compared with usual care.

Conclusions and Relevance

In this cluster randomized clinical trial, no significant difference in the prevalence of opioid cessation was observed after 6 months between the intervention and usual care groups; however, the intervention resulted in more adults reducing their opioid dose compared with usual care.

Trial Registration

ClinicalTrials.gov Identifier: NCT03400384
Treefrog‐Inspired Flexible Electrode with High Permeability, Stable Adhesion, and Robust Durability
Authors: Lan Tianxiang , Tian Hongmiao , Chen Xiaoliang , Li Xiangming , Wang Chunhui , Wang Duorui , Li Sheng , Liu Gangqiang , Zhu Xinkai , Shao Jinyou
Published: May 2024

Long‐term continuous monitoring (LTCM) of physiological electrical signals is an effective means for detecting several cardiovascular diseases. However, the integrated challenges of stable adhesion, low impedance, and robust durability under different skin conditions significantly hinder the application of flexible electrodes in LTCM. This paper proposes a structured electrode inspired by the treefrog web, comprising dispersed pillars at the bottom and asymmetric cone holes at the top. Attachment structures with a dispersed pillar improve the contact stability (adhesion increases 2.79/13.16 times in dry/wet conditions compared to an electrode without structure). Improved permeable duct structure provides high permeability (12 times compared to cotton). Due to high adhesion and permeability, the electrode's durability is 40 times larger than commercial Ag/AgCl electrodes. The treefrog web‐like electrode has great advantages in permeability, adhesion, and durability, resulting in prospects for application in physiological electrical signal detection and a new design idea for LTCM wearable dry electrodes.
All‐Bands‐Flat Floquet Topological Photonic Insulators with Microring Lattices
Authors: Song Hanfa , Van Vien
Published: May 2024

Coupled microring lattices are versatile photonic systems that can be used to realize various topological phases of matter. In two‐dimensional (2D) microring lattices, the periodic and unidirectional circulation of light in each microring gives rise to a time‐like dimension, so that the lattice emulates a (2 + 1)D system with much richer topological behaviors than static 2D lattices. Accurate treatment of these systems requires a departure from the static tight‐binding model of coupled resonators and take into account the periodic coupling sequence of light in the lattice network. This article provides an overview of the theory and design of (2 + 1)D microring lattices for realizing Floquet topological photonic insulators (TPIs). Particular focus is placed on the microring Lieb lattice with perfect couplings, which emulates an anomalous Floquet insulator with all flat bands. Such a system exhibits some unique properties, including wide edge mode continuum exceeding a Floquet–Brillouin zone, super‐robustness to lattice disorder, Aharonov–Bohm (AB) caging and compact localized flat‐band states that can be used to realize high‐quality factor topological resonators. All‐bands‐flat Floquet–Lieb microring lattices provide a versatile platform for investigating topological physics as well as potential applications in realizing topologically‐protected photonic devices.
Heteroatom(S) (N, S, P) Co‐Doped Reduced Graphene Oxide‐Based Binder‐Free Novel Energy Storage Electrode Material for High Energy Density Supercapacitor
Authors: Ahmad Ikrar , Kumar Anil
Published: May 2024

This manuscript reports a one‐pot synthesis of ternary heteroatoms (N/S/P) co‐doped reduced graphene oxide as an electrode material by simultaneous reduction/doping of/into graphene oxide employing eco‐friendly natural molecule(s) (thiamine monophosphate (TM) and thiamine pyrophosphate (TP)) under mild heating (≤60 °C) and near‐neutral pH (≤8) conditions. It produces N, S, P co‐doped rGO‐TM and N, S, P co‐doped rGO‐TP nanohybrids displaying a well‐connected porous microstructure with significantly doped atomic(%) ‐N (10.0%), S (4.1%), P (0.1%) and N (6.7%), S (2.0%), and P (0.5%), respectively. The symmetric supercapacitor designed using N, S, P‐rGO‐TM‐10 in water‐in‐salt 17 m NaClO4 electrolyte exhibits stable cell voltage of 3.0 V, superb gravimetric energy density (areal energy density) of 47.9 Wh kg−1@522.8 W g−1 (0.2363 Wh cm−2@ 2.5 W cm−2); the excellent cyclic stability (88.8 %) and Coulombic efficiency (99.2%) even after 20 000 cycles. Their energy storage capability is corroborated by the illumination of 109 white LEDs upon lighting a single SSC for 50 s each, driving a motor to run a fan, and forming the tandem device by joining three such cells in series.
A data‐driven topsoil classification framework to support soil health assessment in Minnesota
Authors: Blair Hava K. , Gutknecht Jessica L. , Cates Anna M. , Lewandowski Ann Marcelle , Jelinski Nicolas Adam
Published: May 2024

Soil health assessments aim to quantify soil health status using indicators linked to ecosystem services such as yield, nutrient cycling, water cycling, or carbon storage. Many indicators are related to soil biological processes, which can be challenging to interpret because they are sensitive not only to management, but also to nonmanagement variables such as soil inherent properties, topography, and climate. Existing studies address this challenge by grouping similar soils by taxonomy, geography, or a combination of these and other variables for soil health assessment. We investigated whether grouping soils based on multiple quantitative topsoil properties could be an alternative to taxonomic or geographic groups. We used an unsupervised classification algorithm,k‐means, to cluster publicly available soil and climate data for Minnesota. Clustering into eight conceptual groups (“clusters”) based on 10 topsoil properties was determined to be the optimal algorithm output. We evaluated the ability of our soil clusters and other grouping methods to explain variance in eight soil health indicators. We found the combination of Major Land Resource Area (MLRA) and soil cluster performed best, explaining as much or more variance than other groupings for five of the eight indicators. The clusters distinguish zones of topsoil variation at the field scale, and MLRAs account for broader scale variation in climate and other landscape factors. The approach we describe is flexible and could be applied at different locations and scales to produce conceptual soil groups and associated maps to support soil health test sampling and interpretation at the field scale.
Trajectory Planning for Multiple Autonomous Vehicles at Short‐Distance Tandem Signalized Intersections Based on Rule‐Free Framework
Authors: Lin Wenfeng , Hu Xiaowei , Wang Jian
Published: May 2024

High‐level autonomous vehicles (AVs) have more possibilities for improving traffic efficiency. The improvement of traffic efficiency for mixed flow at near‐saturated short‐distance tandem signalized intersections (STSI) needs attention. Most of the existing studies design a generalized control rule for AVs, ignoring the heterogeneity among different AVs. Herein, a multivehicle trajectory planning framework based on a multiagent reinforcement learning (MRL) algorithm is designed to heuristically explore the optimal traffic efficiency of mixed flow at STSI. The core algorithm of this framework is improved from the classical MRL algorithm multi‐agent proximal policy optimization based on the idea of the virtual group instead of designing control rules. The trajectories planned by the framework show outstanding performance in improving throughputs and reducing emissions at the global system level, comparing natural driving, classic adaptive cruise control model and cooperative adaptive cruise control model. The framework can be used to explore optimal traffic efficiency for mixed flow and better heterogeneous rules for high‐level AVs.
A Review of Somatic Design for Soft Robotic Grippers: From Parts Integration to Functional Synergy
Authors: Xu Zhidong , Shi Peipei , Yan Jihong , Zhao Jie
Published: May 2024

Somatic design is crucial for soft grippers to emulate the embodied intelligence of their biological counterparts, due to the blurry boundaries among material, structure, and function. There are five critical parts in somatic design, including morphology, material, fabrication, actuation, and variable stiffness. The strong nonlinear coupling among these factors often leads to mutual influence and functional compromise after integration. Herein, methods and strategies harnessed in these parts for performance improvement of soft grippers are systematically reviewed, particularly clarifying how to exert the coupling enhancement effects of the somatic parts for functional synergy. Finally, the remaining challenges and the future development directions of soft grippers for organism‐like intelligence and wide‐range applications are discussed.
NetHD: Neurally Inspired Integration of Communication and Learning in Hyperspace
Authors: Poduval Prathyush P. , Ni Yang , Zou Zhuowen , Ni Kai , Imani Mohsen
Published: May 2024

The 6G network, the next‐generation communication system, is envisaged to provide unprecedented experience through hyperconnectivity involving everything. The communication should hold artificial intelligence‐centric network infrastructures as interconnecting a swarm of machines. However, existing network systems use orthogonal modulation and costly error correction code; they are very sensitive to noise and rely on many processing layers. These schemes impose significant overhead on low‐power internet of things devices connected to noisy networks. Herein, a hyperdimensional network‐based system, called , is proposed, which enables robust and efficient data communication/learning. exploits a redundant and holographic representation of hyperdimensional computing (HDC) to design highly robust data modulation, enabling two functionalities on transmitted data: 1) an iterative decoding method that translates the vector back to the original data without error correction mechanisms, or 2) a native hyperdimensional learning technique on transmitted data with no need for costly data decoding. A hardware accelerator that supports both data decoding and hyperdimensional learning using a unified accelerator is also developed. The evaluation shows that provides a bit error rate comparable to that of state‐of‐the‐art modulation schemes while achieving 9.4 faster and 27.8 higher energy efficiency compared to state‐of‐the‐art deep learning systems.
Usefulness and drawbacks of comparing balloon‐expandable and self‐expanding TAV
Authors: De Backer Ole , Van Belle Eric
Published: May 2024

Key points

TAVR procedures performed with new‐generation balloon‐expandable and self‐expanding valves had comparable in‐hospital outcomes in the Brazilian RIBAC‐NT registry.

Center and operator volumes have an impact on TAVR outcomes; this makes a point to opt for highvolume centralized TAVR centres.

The future will tell whether comparative TAVR studies are truly meaningful in an era of a more patient‐tailored TAVR approach and device choice.
Percutaneous axillary extracorporeal membrane oxygenation supported complex left main bifurcation percutaneous coronary intervention
Authors: Rohm Charlene L. , Pasrija Chetan , Raj Leah M.
Published: May 2024

A 66‐year‐old man with multiple comorbidities including severe peripheral artery disease and heart failure with reduced ejection fraction presented with complex coronary artery disease with an elevated Society of Thoracic Surgeons Predicted Risk of Mortality for coronary artery bypass grafting and a Synergy Between Percutaneous Coronary Intervention With Taxus and Cardiac Surgery score of 18. With a multidisciplinary heart team approach, the patient successfully underwent percutaneous axillary venoarterial extracorporeal membrane oxygenation (VA‐ECMO) supported high‐risk percutaneous coronary intervention of a heavily calcified left main bifurcation lesion. Given the patient's peripheral artery disease, alternative arterial access for ECMO cannulation was performed percutaneously via the right axillary artery. Additionally, adequate coronary calcium modification was critical to successful stenting of a heavily calcified left main bifurcation. This case highlights a novel approach to obtaining alternative arterial access for ECMO cannulation and emphasizes the importance of calcium modification to achieve excellent stent results.
Hospital readmission prediction with hybrid‐sampling and self‐paced balance learning
Authors: Xu Ying , Zhang Ning , Wang Ao , Feng Tao , Du Guodong
Published: May 2024

Hospital readmission prediction is defined as an evaluation task to model the historical medical data to predict whether patients will be readmitted after discharge. In the past few years, many feasible and effective prediction methods have been proposed, however, most of them neglect the imbalanced distribution of medical data, which causes great difficulties in modeling. Thus, we proposed a new hospital readmission prediction method, which utilizes hybrid‐sampling and self‐paced balance learning strategies to solve the class‐imbalance problem. To be specifically, we first employ an interference negative sample deletion strategy to reduce the probability of important majority class samples being deleted. Then, we design a hard positive sample generation strategy to generate more positive samples. Meanwhile, we also introduce a self‐paced balance factor during the oversampling process to improve the similarity between newly generated minority class samples and hard positive samples. Finally, we perform the experiments on six real‐world readmission datasets to indicate the superiority of the proposed method.
150 Years of Soil
Authors: Joosse Tess
Published: May 2024

Soil archives capture time in a bottle and enable researchers to study soil change over time. A recently re‐discovered archive of soils across Illinois stretching back to 1862 offers a rare chance to probe how agriculture has changed soils in the Prairie State.
Family structure and material hardship: Child and adolescent pathways to health and well‐being
Authors: Miller Ashley , Johnston Carol A.
Published: May 2024

Children's early experiences have potential to shape their development through early childhood, middle childhood, and into adolescence. Family structure at birth and material hardship may offer insight into how children's health and well‐being are shaped within their family of origin. The current paper examined (a) the association between family structure at birth and material hardship 1‐year post‐birth and (b) the differential impact of race on the associations between family structure and material hardship. We further explored the association between family structure and material hardship on self‐reported health in (a) middle childhood and (b) adolescence. Using the Future of Families and Child Wellbeing dataset, an ordinary least squares (OLS) regressions and structural equation path models (SEM) were used to examine associations between family structure, material hardship, and health outcomes (body mass index [BMI], anxiety, and suicidal ideation). Results indicated that family structure predicted material hardship at 1‐year until maternal characteristics were taken into account. Race/ethnicity did not moderate the association. Also, family structure at birth was indirectly associated with youth anxiety through material hardship but did not account for BMI or sucidical ideation. Social supports and state policies should prioritize maternal health access and ensure families are able to meet their basic needs to mitigate children's health risks.
Opening the first and only public in vitro fertilization (IVF) center in sub‐Saharan Africa: The experience of Ethiopia
Authors: Sium Abraham Fessehaye , Surur Feiruz , Negash Mustefa
Published: May 2024

Synopsis

Opening public in vitro fertilization (IVF) center in low‐income countries is feasible and sustainable.
Ambulatory care hematology/oncology pharmacy services: A comprehensive review by the Saudi Oncology Pharmacy Assembly
Authors: Alsuhebany Nada , Alkhudair Nora , Alzahrani Mohammed , Alnajjar Fouad , Alrajhi Abdullah M. , Aldoughaim Maha , Alnuhait Mohammed , Alharbi Atika , Alshamrani Majed , Alshaya Omar
Published: May 2024

Saudi Vision 2030 has driven significant changes in ambulatory care pharmacy services in the Kingdom of Saudi Arabia (KSA), transitioning pharmaceutical care from inpatient to outpatient settings. With a growing need to address non‐communicable diseases, particularly cancer, ambulatory care oncology pharmacy services are of paramount importance. This study aims to evaluate the potential benefits and challenges of establishing such services in the KSA and offers recommendations for clinical pharmacists. A comprehensive literature search was conducted using PubMed, MEDLINE, EMBASE, and Google Scholar, encompassing research from inception to September 2023. The search focused on English language studies related to ambulatory care oncology/hematology pharmacy services. Among the 1351 studies found, those assessing the impact of clinical pharmacists on patient outcomes in outpatient oncology clinics were included. The review of the literature highlights the substantial impact of clinical pharmacists in outpatient hematology/oncology settings. A selection of several studies revealed their role in improving patient care, reducing health care costs, and enhancing treatment outcomes. Notable findings include a high acceptance rate of pharmacist interventions with significant cost savings, increased pharmacist involvement in patient encounters, and reduced emergency department visits and inpatient admissions due to pharmacist interventions. These results showed the valuable contributions of clinical pharmacists in the international outpatient oncology setting. Establishing ambulatory care hematology/oncology pharmacy services in Saudi Arabia is critical, considering the rising cancer burden. The value of specialized oncology clinical pharmacists in the outpatient setting is emphasized by various studies conducted in the United States. This review proposes a framework for patient‐centered oncology practices, serving as a valuable resource for the strategic development of ambulatory care oncology pharmacy services in Saudi Arabia. These efforts align with Saudi Vision 2030's broader goals of enhancing health care quality and patient care.
Pharmacist administered parenteral medications: A descriptive report of an inpatient training program
Authors: Dillon Ryan C. , Leffler Carmen , Schell Ryan F. , Sherlin Kristen C. , Fleenor L. Montana , McLaughlin Linda B.
Published: May 2024

Introduction

Parenteral medication administration is a crucial aspect of in‐hospital patient care and has been historically managed by nurses and physicians. Despite pharmacists' extensive training in the medication use process, their underutilization in medication administration stems from various factors, including the lack of formalized training, limited awareness by other healthcare professionals, and unclear legal guidance. This report discusses the implementation and outcomes of a pharmacist medication administration program at a large academic medical center.

Methods

The initiative began by revising hospital policies, enabling pharmacists to administer medications during emergencies. Documentation and communication protocols were established. Training included an online module and hands‐on sessions covering various topics with a focus on parenteral medication administration and medication safety. Following completion of the program, competency of pharmacists was assessed by pharmacists experienced in intravenous administration using simulated patient case scenarios. Following implementation, the frequency and characteristics of pharmacist administered medications were captured and described.

Results

Thirty pharmacists, including 11 residents, participated. Seven pharmacists administered 349 doses of medications to 284 patients in emergency situations. Administrations by pharmacists included 227 titratable infusions, 72 intermittent or continuous infusions, 49 intravenous pushes, and 1 intranasal naloxone. Classes of medications included high risk products such as vasopressors, sedatives, antiarrhythmics, and thrombolytics. No extravasations or infiltrations were reported.

Conclusion

Implementation of the pharmacist medication administration program signifies significant progress in strengthening the pharmacists' role in patient care at the bedside specifically highlighting the competency of pharmacists to administer parenteral products during emergency situations. The absence of adverse events highlights the feasibility and safety of integrating pharmacists into the bedside team. As the landscape of health‐system pharmacy evolves, embracing standardized training programs like ours reemphasize pharmacists' essential contributions to the multidisciplinary healthcare teams, ultimately enhancing patient care and safety.
Evaluation of an initiative to address polypharmacy in hospitalized older adults
Authors: Meaney Calvin J. , Tjota Natalie , Pham Kevin , Prescott Gina , Doloresco Fred , Ott Michael , Wahler Robert , Wikerd Zachary
Published: May 2024

Background

Polypharmacy contributes to medication‐related harm in older adults. Deprescribing interventions are often employed in the outpatient setting, potentially missing patients with limited healthcare access. Hospitalization represents a unique touch point to address polypharmacy in older adults with a multidisciplinary team.

Methods

This retrospective cohort study examined the feasibility and effectiveness of a polypharmacy intervention in hospitalized older adults. The intervention was developed by a multidisciplinary team with a quality improvement framework and implemented by clinical pharmacists on an academic teaching service. Adults aged 65 years and older were included. Pharmacists completed a comprehensive medication review with the identification of medication therapy problems (MTPs), with additional evaluation for polypharmacy (five or more chronic medications) and potentially inappropriate medications (PIMs) using validated tools (Beers and STOPP/START criteria), with recommendations implemented during hospitalization. Descriptive statistics were used to describe the intervention and its outcomes. Reporting followed the SQUIRE statement.

Results

The polypharmacy intervention was provided to 155 patients. Polypharmacy occurred in 98.7% of older adults, whereas 82.6% received at least one PIM (261 total). This demonstrates a significant need for an intervention to address polypharmacy and PIMs during hospitalization. A median of two MTPs was identified per patient (total 287), the most common being adverse drug reaction (present in 52.3% of patients), medication without indication (47.7%), and indication without medication (31%). Opioids were the most common PIM (present in 36.1% of patients), followed by benzodiazepines (10.3%) and skeletal muscle relaxants (8.4%). A total of 40.6% of PIMs were successfully deprescribed at discharge.

Conclusion

Polypharmacy is ubiquitous in hospitalized older adults. A multidisciplinary approach to deprescribing can reduce PIMs during hospitalization.
Detection of early metaphyseal changes in a piglet model of Legg‐Calvé‐Perthes disease using quantitative mapping of MRI relaxation times
Authors: Buko Erick O. , Armstrong Alexandra R. , Laine Jennifer C. , Tóth Ferenc , Johnson Casey P.
Published: May 2024

Legg‐Calvé‐Perthes disease (LCPD) is a childhood hip disorder characterized by ischemic injury to the epiphysis of the femoral head, but changes to the metaphysis have also been implicated in its pathogenesis. Quantitative magnetic resonance imaging (MRI) relaxation time mapping techniques are potentially useful to detect injury in LCPD, but studies to date have focused on the epiphysis. The purpose of this study was to assess whether T2, T1ρ, adiabatic T1ρ, and adiabatic T2ρ relaxation times can detect early metaphyseal changes in an LCPD piglet model. Complete epiphyseal ischemia of one femoral head was surgically induced and confirmed using contrast‐enhanced MRI in n = 10 6‐week‐old piglets; the contralateral side was unoperated. The bilateral hips were imaged 1 week after surgery in vivo at 3T MRI using relaxation time mapping and contrast‐enhanced MRI. Relaxation times and thicknesses of the metaphyseal primary and secondary spongiosa were measured and compared between the ischemic and contralateral‐control femoral heads using paired t‐tests. In the ischemic femoral heads, T2 relaxation times were significantly increased in the primary spongiosa (6.7 ± 9.8 ms, p = 0.029), and T2, T1ρ, adiabatic T1ρ, and adiabatic T2ρ relaxation times were significantly decreased in the secondary spongiosa (respectively: −13.3 ± 9.3 ms, p = 0.013; −32 ± 23 ms, p < 0.001; −43 ± 41 ms, p = 0.009; and −39 ± 13 ms, p < 0.001). The secondary spongiosa thickness was also significantly decreased in the ischemic femoral heads (p < 0.001). In conclusion, T2, T1ρ, adiabatic T1ρ, and adiabatic T2ρ relaxation time mapping techniques can detect early changes in the metaphysis following ischemic injury to the epiphysis of the femoral head in a piglet model of LCPD.
Age‐dependent decline of B3AR agonist‐mediated activation of FAP UCP‐1 expression in murine models of chronic rotator cuff repair
Authors: Diaz Agustin , Sang Luke , Garcia Steven , Wague Aboubacar , Davies Michael , Youn Alex , Liu Xuhui , Feeley Brian T.
Published: May 2024

Amibegron, a β3‐adrenergic receptor (B3AR) agonist, has recently been shown to provide therapeutic effects for chronic rotator cuff (RC) tears by inducing the expression of uncoupling protein 1 (UCP‐1), a marker of brown fat, in fibroadipogenic progenitors (FAPs). However, it remains to be seen if these beneficial effects hold true with age and in older, more clinically relevant populations. This study seeks to understand the impacts of aging on the efficacy of amibegron to treat chronic RC tears. Young (4‐month‐old) and aged (33‐month‐old) C57BL/6 mice underwent a RC injury procedure with delayed repair (DR). Mice were equally randomized to receive amibegron or dimethyl sulfoxide (DMSO) treatments after repair. Functional ability was measured at baseline and 6‐weeks after DR. Wet muscle weight and histology of injured and contralateral supraspinatus were also analyzed 6‐weeks post‐DR. For in vitro histology and real‐time quantitative PCR experiments, FAPs were isolated from young and aged mice via fluorescence‐activated cell sorting. Young and aged FAPs were treated with amibegron or DMSO either immediately after seeding (early exposure) or 8‐days after seeding (late exposure). In vitro results showed that amibegron‐mediated FAP UCP‐1 expression decreases with age. In vivo data demonstrated that aged mice have a decreased responsiveness to amibegron and decreased propensity for intramuscular FAP UCP‐1 expression. Further, delayed amibegron treatment with RC repair did not lead to improvements in muscle atrophy and functional outcomes. Our findings demonstrate that age and the timing of interventions play a critical role in FAP‐targeted therapeutics for chronic injuries.
Development and evaluation of a deep learning framework for the diagnosis of malnutrition using a 3D facial points cloud: A cross‐sectional study
Authors: Wang Xue , Liu Yan , Rong Zhiqin , Wang Weijia , Han Meifen , Chen Moxi , Fu Jin , Chong Yuming , Long Xiao , Tang Yong , Chen Wei
Published: May 2024

Background

The feasibility of diagnosing malnutrition using facial features has been validated. A tool to integrate all facial features associated with malnutrition for disease screening is still demanded. This work aims to develop and evaluate a deep learning (DL) framework to accurately determine malnutrition based on a 3D facial points cloud.

Methods

A group of 482 patients were studied in this perspective work. The 3D facial data were obtained using a 3D camera and represented as a 3D facial points cloud. A DL model, PointNet++, was trained and evaluated using the points cloud as inputs and classified the malnutrition states. The performance was evaluated with the area under the receiver operating characteristic curve, accuracy, specificity, sensitivity, and F1 score.

Results

Among the 482 patients, 150 patients (31.1%) were diagnosed as having moderate malnutrition and 54 patients (11.2%) as having severe malnutrition. The DL model achieved the performance with an area under the receiver operating characteristic curve of 0.7240 ± 0.0416.

Conclusion

The DL model achieved encouraging performance in accurately classifying nutrition states based on a points cloud of 3D facial information of patients with malnutrition.
There is high variability in quantitative measurement techniques in glenohumeral capsular measurements for shoulder instability: A systematic review
Authors: Tisherman Robert T. , Bulleit Clark , Champagne Allen A. , Fatora Gabrielle C. , Lau Brian C.
Published: May 2024

Purpose

Instability of the glenohumeral joint remains a complex clinical issue with high rates of surgical failure and significant morbidity. Advances in specific radiologic measurements involving the glenoid and the humerus have provided insight into glenohumeral pathology, which can be corrected surgically towards improving patient outcomes. The contributions of capsular pathology to ongoing instability remain unclear. The purpose of this study is to provide a systematic review of existing glenohumeral capsular measurement techniques published in the last 15 years.

Methods

A systematic review of multiple databases was performed following PRISMA guidelines for all primary research articles between 2008 and 2023 with quantitative measurements of the glenohumeral capsule in patients with instability, including anterior, posterior and multi‐directional instability.

Results

There were a total of 14 articles meeting the inclusion criteria. High variability in measurement methodology across studies was observed, including variable amounts of intra‐articular contrast, heterogeneity among magnetic resonance sequence acquisitions, differences in measurements performed and the specific approach taken to compute each measurement.

Conclusion

There is a need for standardization of methods in the measurement of glenohumeral capsular pathology in the setting of glenohumeral instability to allow for cross‐study analysis.

Level of Evidence

Level III.
Long‐term patient outcome is affected by deep venous thrombosis after Achilles tendon rupture repair
Authors: Aufwerber Susanna , Svedman Simon , Silbernagel Karin Grävare , Ackermann Paul W.
Published: May 2024

Purpose

The aim of the study was to examine the impact of a deep venous thrombosis (DVT) on patient outcomes 3 years after Achilles tendon rupture (ATR) repair and if there were continued improvements between 1 and 3 years after surgery. A secondary aim was to determine risk factors associated with impaired patient outcomes in the long term.

Methods

This cohort study consisted of 181 ATR‐repaired patients, from two large randomized clinical trials, who attended a 3‐year follow‐up evaluation. Patients were postoperatively randomized to two different weight‐bearing interventions compared with immobilization in a below‐knee plaster cast for 2 weeks. During immobilization, screening for DVT was performed with Doppler ultrasound. At 1 and 3 years postoperatively, functional‐ and patient‐reported outcomes were evaluated by the validated heel‐rise test and self‐reported questionnaire, Achilles tendon Total Rupture Score (ATRS).

Results

In total, 76 out of 181 (42%) patients exhibited a DVT at the 2‐ or 6‐week screening after ATR surgery. Suffering from a DVT during immobilization resulted at 3 years in a worse limb symmetry index (LSI) of heel‐rise total work compared to patients without DVT, adjusted for age (DVT mean LSI 68% vs. no DVT 78%, p = 0.027). At 3 years, patients with a DVT during immobilization displayed lower ATRS (DVT median 88 vs. no DVT 93, p = 0.046), which was not significant after adjustment for age. However, patients with DVT exhibited an improvement in ATRS, LSI total work, and LSI maximum height between 1 and 3 years, which was not seen among patients without DVT. Independent risk factors for reduced patient functional outcomes at 3 years were older age, greater calf muscle hypotrophy, and suffering a DVT.

Conclusions

DVT during immobilization affects patients' long‐term functional outcomes 3 years after ATR repair. Clinicians should adequately address risk factors contributing to impaired patient outcomes in the long term, including calf muscle hypotrophy, DVT, and older age.

Level of Evidence

Level Ⅲ.
Sex‐specific analysis in patients undergoing Talar OsteoPeriostic grafting from the Iliac Crest (TOPIC) for large osteochondral lesions of the talus
Authors: Dahmen Jari , Gianakos Arianna L. , Hollander Julian J. , Rikken Quinten G. H. , Stufkens Sjoerd A. S. , Kerkhoffs Gino M. M. J.
Published: May 2024

Purpose

The purpose of the present study is to assess the gender‐specific differences in the presentation and outcomes following Talar OsteoPeriostic grafting from the Iliac Crest (TOPIC) between male and female patients.

Methods

A prospective comparative analysis was performed comparing consecutive female and male patients having been treated by the press‐fit TOPIC procedure. Clinical comparative assessment preoperatively and at 12 months of follow‐up included determination of the Numeric Rating Scale (NRS) scores for pain during walking (primary outcome), at rest and during stair‐climbing. The Foot and Ankle Outcome Score (FAOS) was also assessed. A computed tomography (CT) scan was performed for lesion size, morphology and localization determination preoperatively as well as 10–12 weeks postoperatively to assess the union of the osteotomy site and at 1 year postoperatively to assess consolidation of the graft as well as intra‐graft cyst development.

Results

A total of 48 patients (30 women, 18 men) were eligible for inclusion. Both men and women demonstrated significant functional improvements postoperatively concerning the clinical outcomes with no significant differences between men and women (n.s.) except for a significantly greater improvement in postoperative FAOS pain scores in women. Men presented with OLTs significantly larger in both surface area (208 mm2 for males versus 155 mm2 for females, p < 0.05) as well as lesion volume (3.0 cm3 for males versus 1.8 cm3 for females, p < 0.05). At 1‐year postoperatively, all patients showed graft consolidation. Cyst formation was present in 11 females (37% of the group) and 10 males (59% of the group), respectively (n.s.).

Conclusion

Both males and females showed clinically relevant improvements in the clinical outcomes after undergoing the TOPIC procedure with significant differences in preoperative lesion size. The TOPIC procedure is a good treatment strategy for large OLTs in both men and women.

Level of Evidence

Level III, comparative prospective clinical cohort.
Health‐related quality of life does not deteriorate while waiting for anterior cruciate reconstruction
Authors: Domerchie Emily , Horner Nolan S. , Mauti Eric , Sedrak Phelopater , Sheehan Brendan , Ayeni Olufemi R. , Farrokyhar Forough , Denkers Matthew , de SA Darren L. , Peterson Devin
Published: May 2024

Purpose

The aim of this study was to determine how preoperative health‐related quality of life (HRQoL) is affected by the duration of the wait time (WT) for anterior cruciate ligament reconstruction (ACLR) once a decision is made to proceed with surgery.

Methods

This was a multi‐centre prospective cohort study. One hundred and twenty‐two patients 14 years of age and above waiting for ACLR completed the International Knee Documentation Committee (IKDC) demographic, current health assessment and subjective knee evaluation (SKF) forms on the day of decision to operate and the day of surgery. Changes in scores were analyzed for the entire cohort, adjusted for WTs and a subset was compared for patients with isolated anterior cruciate ligament (ACL) tears and ACL tears with concurrent meniscal involvement. Changes in HRQoL scores from the day of the decision to operate to the 9‐month postoperative appointments were also assessed.

Results

Energy/Fatigue (p < 0.05), Pain (p < 0.05), General Health (p < 0.05) and the IKDC‐SKF Score (p < 0.05) significantly increased between the day of the decision to operate and the day of surgery. Only the change in IKDC‐SKF score remained significantly higher after adjusting for WT. Baseline HRQoL scores significantly improved by the 9‐month postoperative appointment.

Conclusion

The length of time waiting for ACLR did not adversely influence HRQoL in this study. However, low preoperative HRQoL and the significant improvement in HRQoL of patients followed postoperatively suggest that timely surgery is beneficial for this patient population.

Level of Evidence

Level II.
Robotic‐assisted medial unicompartmental knee arthroplasty restored prearthritic alignment and led to superior functional outcomes compared with conventional techniques
Authors: Kwon Seung Cheol , Jung Ho Jung , Lee Jong Hwa , Hyun Jin Tak , Hwang Ji Hyo , Kim Joong Il
Published: May 2024

Purpose

Robotic‐assisted medial unicompartmental knee arthroplasty (UKA) can ensure precise preoperative planning, minimise soft tissue damage and restore native coronal alignment. However, few studies have investigated how these advantages translate into differences in early postoperative outcomes. This study aimed to compare differences in early outcomes between conventional UKA (C‐UKA) and robotic‐assisted UKA (R‐UKA).

Methods

This retrospective study investigated two groups of patients who underwent medial UKA: C‐UKA group (n = 35) and R‐UKA group (n = 35). We assessed (1) serum indicators (hemoglobin, creatine kinase and C‐reactive protein) and pain visual analogue scale (VAS) at postoperative days (PODs) 1, 2, 4 and 6; (2) radiologic parameters including joint line height change and arithmetic and mechanical hip–knee–ankle angle (aHKA and mHKA); (3) patient‐reported outcomes including Knee Society Scores, Western Ontario and Mcmaster Universities Arthritis Index (WOMAC) and Forgotten Joint Score‐12 (FJS‐12) at 1‐year follow‐up.

Results

Despite similar serum indicator results, pain VAS was lower in the R‐UKA group than in the C‐UKA group at PODs 2 (2.5 ± 1.3 vs. 3.6 ± 1.2, p = 0.02), 4 (2.4 ± 0.9 vs. 3.3 ± 1.0, p = 0.03) and 6 (1.9 ± 1.1 vs. 3.1 ± 1.1, p < 0.01). The joint line height change was significantly lower in the R‐UKA group than in the C‐UKA group (0.9 mm ± 0.6 mm vs. 2.0 mm ± 1.3 mm, p = 0.02). The equivalence test for preoperative aHKA and postoperative mHKA revealed equivalence in only the R‐UKA group (p < 0.01). The R‐UKA group showed better WOMAC and FJS‐12 compared to C‐UKA group at 1‐year follow‐up.

Conclusion

R‐UKA led to lower pain VAS in the early postoperative period compared with C‐UKA. Additionally, R‐UKA effectively restored the joint line and prearthritic lower limb alignment, resulting in superior functional outcomes at 1‐year follow‐up compared with C‐UKA.

Level of Evidence

Level III.
Development of TRIP phenomenon using power refining of retained austenite by niobium
Authors: Shash A. Y. , El‐Fawakhry M. K. , Gamal A. , Zaki A. I. , El‐Sherbiny M. G.
Published: May 2024

The illustrations above demonstrate that as the percentage of niobium increases, the grain size decreases, leading to an increase in the stability of transformation induced plasticity steel. This, in turn, results in improved mechanical strength. The optimal volume fraction of retained austenite for a significant transformation induced plasticity effect to occur is reported to be in the range of 10 vol. %–20 vol. %. The volume fraction of retained austenite directly determines the carbon content and grain size of the retained austenite, its two main stabilization factors. The stability of the retained austenite dictates when the strain‐induced martensite transformation (SIMT) occurs during straining of transformation induced plasticity high strength steel. Unstable retained austenite transforms almost immediately upon deformation, increasing work hardening rate and formability during the stamping process. At the appropriate stability of the retained austenite, the Strain‐Induced Martensite Transformation begins only at strain levels beyond those produced during stamping and forming, and the retained austenite is still present in the final part; it can transform into martensite in the event of a crash, providing greater crash energy absorption. The tensile strength level of micro‐alloyed transformation induced plasticity steels may exceed 1 GPa. Grain refinement mechanism is considered as the most applied mechanism used in increasing of steel strength without deterioration of ductility and toughness. Recently, it was proposed that the grain refinement could act positively on promoting the transformation induced plasticity effect of advanced high strength steel through improving the stability of retained austenite. In this research, quenching and partitioning heat treatment technique was applied to four grades of low carbon steel with different percentage of niobium. Then, the effect of niobium on grain refinement has been detected by microstructure observations. Mechanical properties and strain hardening properties of investigated steel have been determined. In addition, by using x‐ray diffraction, as well as a new electric resistance‐based sensor, it was possible to characterize the stability of the retained austenite through the plastic deformation of steel. Grain refinement by using of niobium has a great impact on promoting the stability of retained austenite against the plastic stress at the plastic deformation zone.
Direct consolidation of an oxide dispersion strengthened alloy by hot rotary swaging
Authors: Kunčická L. , Svoboda J.
Published: May 2024

Steels strengthened by alloying elements and precipitates typically maintain their enhanced properties up to the ferrite‐austenite transformation. However, oxide dispersion strengthened ferritic steels are creep resistant even at much higher temperatures given by dispersions of nanosized oxides. To ensure homogeneous dispersion of the oxides, powder metallurgy is used for preparation of the original material. The presented study investigates the effects of direct consolidation of powder of ferritic steel strengthened with yttrium oxide nanoparticles. The powders were mechanically alloyed and sealed into evacuated steel containers, which were subjected to gradual hot consolidation via the industrially applicable intensive plastic deformation method of rotary swaging. Investigations assessing the effects of several reduction ratios showed that the direct consolidation of the oxide dispersion strengthened steel was successful – in the macroscale – at the swaging ratio of 1.03; the quality of consolidation further increased with increasing swaging ratio. At the swaging ratio of 1.83, the consolidated bulk material featured ultra‐fine grains characterized with high angle grain boundaries, homogeneous dispersion of oxide precipitates, and the average Vickers microhardness of 706.6 HV 1.
Evaluation of the influence of the material composition on the peel behavior of adhesive and cohesive peel systems using experimental fracture mechanics methods
Authors: Nase M. , Zankel A.
Published: May 2024

The study focusses on a low‐density polyethylene/isotactic polybutene‐1 peel system with low‐density polyethylene as matrix and isotactic polybutene‐1 as peel component sealed against itself (cohesive peel system), and on an ethylene vinyl acetate/linear low‐density polyethylene peel system with ethylene vinyl acetate as matrix and linear low‐density polyethylene as peel component sealed against polyethylene terephthalate (adhesive peel system). Due to a new approach to estimate the true fracture surface using 3D reconstruction, it was possible to determine the true adhesive energy release rate, especially for cohesive peel systems. This enables a direct comparison of the fracture mechanics parameters determined from both types of peel systems. The results reveal that the recipe has a distinct influence on the peel behavior. An increasing amount of the used peel component leads in any case to a decrease of the peel force as well as of the energy release rate for both, sealed adhesive and cohesive peel systems. Using application engineering examples generalizable relationships between structure and properties of peel systems could be estimated and the structure sensitivity of the fracture mechanical parameters could be proven.