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Background: High bone mass (HBM, BMD Z-score ≥  + 3.2) and cam morphology (bulging of lateral femoral head) are associated with greater odds of prevalent radiographic hip osteoarthritis (rHOA). As cam morphology is itself a manifestation of increased bone deposition around the femoral head, it is conceivable that cam morphology may mediate the relationship between HBM and rHOA. We therefore aimed to determine if individuals with HBM have increased odds of prevalent cam morphology. In addition, we investigated whether the relationship between cam and prevalent and incident osteoarthritis was preserved in a HBM population.Methods: In the HBM study, a UK based cohort of adults with unexplained HBM and their relatives and spouses (controls), we determined the presence of cam morphology using semi-automatic methods of alpha angle derivation from pelvic radiographs. Associations between HBM status and presence of cam morphology, and between cam morphology and presence of rHOA (or its subphenotypes: osteophytes, joint space narrowing, cysts, and subchondral sclerosis) were determined using multivariable logistic regression, adjusting for age, sex, height, weight, and adolescent physical activity levels. The association between cam at baseline and incidence of rHOA after an average of 8 years was determined. Generalised estimating equations accounted for individual-level clustering.Results: The study included 352 individuals, of whom 235 (66.7%) were female and 234 (66.5%) had HBM. Included individuals contributed 694 hips, of which 143 had a cam deformity (20.6%). There was no evidence of an association between HBM and cam morphology (OR = 0.97 [95% CI: 0.63-1.51], p = 0.90) but a strong relationship was observed between cam morphology and rHOA (OR = 3.96 [2.63-5.98], p = 5.46 × 10-11) and rHOA subphenotypes joint space narrowing (OR = 3.70 [2.48-5.54], p = 1.76 × 10-10), subchondral sclerosis (OR = 3.28 [1.60-6.60], p = 9.57 × 10-4) and osteophytes (OR = 3.01 [1.87-4.87], p = 6.37 × 10-6). Cam morphology was not associated with incident osteoarthritis (OR = 0.76 [0.16-3.49], p = 0.72).Conclusions: The relationship between cam morphology and rHOA seen in other studies is preserved in a HBM population. This study suggests that the risk of OA conferred by high BMD and by cam morphology are mediated via distinct pathways. [ABSTRACT FROM AUTHOR]

Background: To synthesise the evidence for the effectiveness of inpatient rehabilitation treatment ingredients (versus any comparison) on functioning, quality of life, length of stay, discharge destination, and mortality among older adults with an unplanned hospital admission.Methods: A systematic search of Cochrane Library, MEDLINE, Embase, PsychInfo, PEDro, BASE, and OpenGrey for published and unpublished systematic reviews of inpatient rehabilitation interventions for older adults following an unplanned admission to hospital from database inception to December 2020. Duplicate screening for eligibility, quality assessment, and data extraction including extraction of treatment components and their respective ingredients employing the Treatment Theory framework. Random effects meta-analyses were completed overall and by treatment ingredient. Statistical heterogeneity was assessed with the inconsistency-value (I2).Results: Systematic reviews (n = 12) of moderate to low quality, including 44 non-overlapping relevant RCTs were included. When incorporated in a rehabilitation intervention, there was a large effect of endurance exercise, early intervention and shaping knowledge on walking endurance after the inpatient stay versus comparison. Early intervention, repeated practice activities, goals and planning, increased medical care and/or discharge planning increased the likelihood of discharge home versus comparison. The evidence for activities of daily living (ADL) was conflicting. Rehabilitation interventions were not effective for functional mobility, strength, or quality of life, or reduce length of stay or mortality. Therefore, we did not explore the potential role of treatment ingredients for these outcomes.Conclusion: Benefits observed were often for subgroups of the older adult population e.g., endurance exercise was effective for endurance in older adults with chronic obstructive pulmonary disease, and early intervention was effective for endurance for those with hip fracture. Future research should determine whether the effectiveness of these treatment ingredients observed in subgroups, are generalisable to older adults more broadly. There is a need for more transparent reporting of intervention components and ingredients according to established frameworks to enable future synthesis and/or replication.Trial Registration: PROSPERO Registration CRD42018114323 . [ABSTRACT FROM AUTHOR]

Summary: Additional physiotherapy in the first postoperative week was associated with fewer days to discharge after hip fracture surgery. A 7-day physiotherapy service in the first postoperative week should be considered as a new key performance indicator in evaluating the quality of care for patients admitted with a hip fracture. Introduction : To examine the association between physiotherapy in the first week after hip fracture surgery and discharge from acute hospital. Methods: We linked data from the UK Physiotherapy Hip Fracture Sprint Audit to hospital records for 5395 patients with hip fracture in May and June 2017. We estimated the association between the number of days patients received physiotherapy in the first postoperative week; its overall duration (< 2 h, ≥ 2 h; 30-min increment) and type (mobilisation alone, mobilisation and exercise) and the cumulative probability of discharge from acute hospital over 30 days, using proportional odds regression adjusted for confounders and the competing risk of death. Results: The crude and adjusted odds ratios of discharge were 1.24 (95% CI 1.19–1.30) and 1.26 (95% CI 1.19–1.33) for an additional day of physiotherapy, 1.34 (95% CI 1.18–1.52) and 1.33 (95% CI 1.12–1.57) for ≥ 2 versus < 2 h physiotherapy, and 1.11 (95% CI 1.08–1.15) and 1.10 (95% CI 1.05–1.15) for an additional 30-min of physiotherapy. Physiotherapy type was not associated with discharge. Conclusion: We report an association between physiotherapy and discharge after hip fracture. An average UK hospital admitting 375 patients annually may save 456 bed-days if current provision increased so all patients with hip fracture received physiotherapy on 6–7 days in the first postoperative week. A 7-day physiotherapy service totalling at least 2 h in the first postoperative week may be considered a key performance indicator of acute care quality after hip fracture. [ABSTRACT FROM AUTHOR]

Hip fractures are a major cause of morbidity and mortality in the elderly, and incur high health and social care costs. Given projected population ageing, the number of incident hip fractures is predicted to increase globally. As fracture classification strongly determines the chosen surgical treatment, differences in fracture classification influence patient outcomes and treatment costs. We aimed to create a machine learning method for identifying and classifying hip fractures, and to compare its performance to experienced human observers. We used 3659 hip radiographs, classified by at least two expert clinicians. The machine learning method was able to classify hip fractures with 19% greater accuracy than humans, achieving overall accuracy of 92%. [ABSTRACT FROM AUTHOR]

Summary: We found social deprivation to be associated with higher mortality in the year following hip fracture among men and women aged 60 years and older in England. In those who did survive, deprivation was associated with longer hospital stays and greater risk of subsequent emergency readmission particularly for patients with dementia. Introduction: Social deprivation predicts a range of adverse health outcomes; however, its impact on outcomes following hip fracture is not established. We examined the effect of area-level social deprivation on outcomes following hospital admission for hip fracture in England. Methods: We used English Hospital Episodes Statistics linked to the National Hip Fracture Database (April 2011–March 2015) and Office for National Statistics mortality database, to identify patients aged 60+ years admitted with hip fracture. Deprivation was measured using Index of Multiple Deprivation quintiles; Q1-least deprived; Q5-most deprived, and outcomes by mortality over 1-year, length-of-stay in NHS acute and rehabilitation hospitals ('superspell'), and emergency 30-day readmission. Results: We identified 218,907 admissions with an index hip fracture (mean age 82.8 [standard deviation, SD 8.4] years; 72.6% female). Each quintile of deprivation was associated with greater mortality; age-adjusted 30-day mortality odds ratio, OR 1.30 [95% confidence interval, CI: 1.24, 1.37], p < 0.001, equating to on average 1038 fewer deaths/year among those who are least deprived (Q1 versus 2–5). Similarly, at 365 days, those most deprived had 24% higher mortality (age-sex-comorbidity-adjusted OR:1.24 [1.20, 1.28], p < 0.001; Q5 versus Q1). Among survivors, mean superspell was longer in the most versus least deprived (Q5:24.4 [SD 21.7] days, Q1:23.3 [SD 22.1], p < 0.001). Readmission was more common in those most versus least deprived (age-sex-comorbidity-adjusted OR 1.27 [1.22, 1.32], p < 0.001). Conclusion: Greater deprivation is associated with reduced survival at all timepoints in the year following hip fracture. Among survivors, hospital stay is increased as is readmission risk. The extent to which configuration of English hospital services, rather than patient case-mix, explains these apparent health inequalities remains to be determined. [ABSTRACT FROM AUTHOR]

Purpose of Review: This paper reviews how bone genetics has contributed to our understanding of the pathogenesis of osteoarthritis. As well as identifying specific genetic mechanisms involved in osteoporosis which also contribute to osteoarthritis, we review whether bone mineral density (BMD) plays a causal role in OA development. Recent Findings: We examined whether those genetically predisposed to elevated BMD are at increased risk of developing OA, using our high bone mass (HBM) cohort. HBM individuals were found to have a greater prevalence of OA compared with family controls and greater development of radiographic features of OA over 8 years, with predominantly osteophytic OA. Initial Mendelian randomisation analysis provided additional support for a causal effect of increased BMD on increased OA risk. In contrast, more recent investigation estimates this relationship to be bi-directional. However, both these findings could be explained instead by shared biological pathways. Summary: Pathways which contribute to BMD appear to play an important role in OA development, likely reflecting shared common mechanisms as opposed to a causal effect of raised BMD on OA. Studies in HBM individuals suggest this reflects an important role of mechanisms involved in bone formation in OA development; however further work is required to establish whether the same applies to more common forms of OA within the general population. [ABSTRACT FROM AUTHOR]

Summary: Individuals with low socio-economic status (SES) have a higher risk of dying following hip fracture compared with individuals with high SES. Evidence on social inequalities in non-hip fractures is lacking as well as evidence on the impact of SES on health-related quality of life post fracture. Introduction: Fragility fractures, especially of the hip, cause substantial excess mortality and impairment in health-related quality of life (HRQoL). This systematic review and meta-analysis aimed to investigate the association between socio-economic status (SES) and post-fracture mortality and HRQoL. Methods: PubMed, EMBASE and CINAHL databases were searched from inception to the last week of November 2018 for studies reporting an association between SES and post-fracture mortality and/or HRQoL among people aged ≥ 50 years. Risk ratios (RRs) were meta-analyzed using a standard inverse-variance-weighted random effects model. Studies using individual-level and area-based SES measures were analyzed separately. Results: A total of 24 studies from 15 different countries and involving more than one million patients with hip fractures were included. The overall risk of mortality within 1-year post-hip fracture in individuals with low SES was 24% higher than in individuals with high SES (RR 1.24, 95% CI 1.19 to 1.29) for individual-level SES measures, and 14% (RR 1.14, 95% CI 1.09 to 1.19) for area-based SES measures. The quality of the evidence for the outcome mortality was moderate. Using individual SES measures, we estimated the excess HRQoL loss to be 5% (95% CI − 1 to 10%) among hip fracture patients with low SES compared with high SES. Conclusions: We found a consistently increased risk of post-hip fracture mortality with low SES across SES measures and across countries with different political structures and different health and social care infrastructures. The impact of SES on post-fracture HRQoL remains uncertain due to sparse and low-quality evidence. [ABSTRACT FROM AUTHOR]

The article presents a systematic review which examined the effects of equity factors to the eligibility criteria of rehabilitation intervention trials in hip fracture patients. Other topics include the founding principle of equity in access to healthcare of the National Health Service in Great Britain, as well as the factors affecting equity like age, time-dependent relationships, socioeconomic status, and gender.

Summary: Deprivation predicts increased hip fracture risk. Over 14 years, hip fracture incidence increased among men with persisting inequalities. Among women, inequalities in incidence were less pronounced; whilst incidence decreased overall, this improvement was seen marginally less in women from the most deprived areas. Hip fracture prevention programmes have not reduced inequalities. Purpose: Deprivation is associated with increased hip fracture risk. We examined the effect of area-level deprivation on hip fracture incidence in England over 14 years to determine whether inequalities have changed over time. Methods: We used English Hospital Episodes Statistics (2001/2002-2014/2015) to identify hip fractures in adults aged 50+ years and mid-year population estimates (2001-2014) from the Office for National Statistics. The Index of Multiple Deprivation measured local area deprivation. We calculated age-adjusted incidence rate ratios (IRR) for hip fracture, stratified by gender and deprivation quintiles. Results: Over 14 years, we identified 747,369 hospital admissions with an index hip fracture; the number increased from 50,640 in 2001 to 55,092 in 2014; the proportion of men increased from 22.2% to 29.6%. Whereas incidence rates decreased in women (annual reduction 1.1%), they increased in men (annual increase 0.6%) (interaction p < 0.001). Incidence was higher in more deprived areas, particularly among men: IRR most vs. least deprived quintile 1.50 [95% CI 1.48, 1.52] in men, 1.17 [1.16, 1.18] in women. Age-standardised incidence increased for men across all deprivation quintiles from 2001 to 2014. Among women, incidence fell more among those least compared to most deprived (year by deprivation interaction p < 0.001). Conclusions: Deprivation is a stronger relative predictor of hip fracture incidence in men than in women. However, given their higher hip fracture incidence, the absolute burden of deprivation on hip fractures is greater in women. Despite public health efforts to prevent hip fractures, the health inequality gap for hip fracture incidence has not narrowed for men, and marginally widened among women. [ABSTRACT FROM AUTHOR]

Summary: In this study, we report that self-perception of fracture risk captures some aspect of fracture risk not currently measured using conventional fracture prediction tools and is associated with improved medication uptake. It suggests that adequate appreciation of fracture risk may be beneficial and lead to greater healthcare engagement and treatment. Introduction: This study aimed to assess how well self-perception of fracture risk, and fracture risk as estimated by the fracture prediction tool FRAX, related to fracture incidence and uptake and persistence of anti-osteoporosis medication among women participating in the Global Longitudinal study of Osteoporosis in Women (GLOW). Methods: GLOW is an international cohort study involving 723 physician practices across 10 countries in Europe, North America and Australia. Aged ≥ 55 years, 60,393 women completed baseline questionnaires detailing medical history, including co-morbidities, fractures and self-perceived fracture risk (SPR). Annual follow-up included self-reported incident fractures and anti-osteoporosis medication (AOM) use. We calculated FRAX risk without bone mineral density measurement. Results: Of the 39,241 women with at least 1 year of follow-up data, 2132 (5.4%) sustained an incident major osteoporotic fracture over 5 years of follow-up. Within each SPR category, risk of fracture increased as the FRAX categorisation of risk increased. In GLOW, only 11% of women with a lower baseline SPR were taking AOM at baseline, compared with 46% of women with a higher SPR. AOM use tended to increase in the years after a reported fracture. However, women with a lower SPR who were fractured still reported lower AOM rates than women with or without a fracture but had a higher SPR. Conclusions: These results suggest that SPR captures some aspect of fracture risk not currently measured using conventional fracture prediction tools and is also associated with improved medication uptake. [ABSTRACT FROM AUTHOR]

Introduction: In 2008, the UK National Osteoporosis Guideline Group (NOGG) produced a guideline on the prevention and treatment of osteoporosis, with an update in 2013. This paper presents a major update of the guideline, the scope of which is to review the assessment and management of osteoporosis and the prevention of fragility fractures in postmenopausal women and men age 50 years or over. Methods: Where available, systematic reviews, meta-analyses and randomised controlled trials were used to provide the evidence base. Conclusions and recommendations were systematically graded according to the strength of the available evidence. Results: Review of the evidence and recommendations are provided for the diagnosis of osteoporosis, fracture-risk assessment, lifestyle measures and pharmacological interventions, duration and monitoring of bisphosphonate therapy, glucocorticoid-induced osteoporosis, osteoporosis in men, postfracture care and intervention thresholds. Conclusion: The guideline, which has received accreditation from the National Institute of Health and Care Excellence (NICE), provides a comprehensive overview of the assessment and management of osteoporosis for all healthcare professionals who are involved in its management. [ABSTRACT FROM AUTHOR]

Batch distribution studies show that above ~1 M HNO3Np(IV) and Np(VI) are well extracted into a solvent of 0.2 M TODGA/0.5 M DMDOHEMA in kerosene that has been formulated for the extraction of transuranic actinides in the GANEX (grouped actinide extraction) process. Np(IV) and Np(VI) are quite stable in the solvent phase, although Np(VI) is slowly reduced to Np(IV) on standing. Stripping of Np(IV,VI) ions from the GANEX solvent has been shown to be quite efficient using acetohydroxamic acid providing aqueous HNO3concentrations are below ~0.3 M. In contrast, Np(V) shows much lower distribution ratios and is unstable in the GANEX solvent phase with quite rapid formation of Np(IV) observed. Closer analysis shows this to be due to Np(V) disproportionation, which is enhanced at higher organic phase acidities. Disproportionation of Np(V) is also shown to occur in separate TODGA and DMDOHEMA kerosene solutions. These observations thus enable conditions for neptunium extraction to be optimized during the design of a GANEX flowsheet. [ABSTRACT FROM AUTHOR]

Summary: High bone mineral density on routine dual energy X-ray absorptiometry (DXA) may indicate an underlying skeletal dysplasia. Two hundred fifty-eight individuals with unexplained high bone mass (HBM), 236 relatives (41% with HBM) and 58 spouses were studied. Cases could not float, had mandible enlargement, extra bone, broad frames, larger shoe sizes and increased body mass index (BMI). HBM cases may harbour an underlying genetic disorder. Introduction: High bone mineral density is a sporadic incidental finding on routine DXA scanning of apparently asymptomatic individuals. Such individuals may have an underlying skeletal dysplasia, as seen in LRP5 mutations. We aimed to characterize unexplained HBM and determine the potential for an underlying skeletal dysplasia. Methods: Two hundred fifty-eight individuals with unexplained HBM (defined as L1 Z-score ≥ +3.2 plus total hip Z-score ≥ +1.2, or total hip Z-score ≥ +3.2) were recruited from 15 UK centres, by screening 335,115 DXA scans. Unexplained HBM affected 0.181% of DXA scans. Next 236 relatives were recruited of whom 94 (41%) had HBM (defined as L1 Z-score + total hip Z-score ≥ +3.2). Fifty-eight spouses were also recruited together with the unaffected relatives as controls. Phenotypes of cases and controls, obtained from clinical assessment, were compared using random-effects linear and logistic regression models, clustered by family, adjusted for confounders, including age and sex. Results: Individuals with unexplained HBM had an excess of sinking when swimming (7.11 [3.65, 13.84], p < 0.001; adjusted odds ratio with 95% confidence interval shown), mandible enlargement (4.16 [2.34, 7.39], p < 0.001), extra bone at tendon/ligament insertions (2.07 [1.13, 3.78], p = 0.018) and broad frame (3.55 [2.12, 5.95], p < 0.001). HBM cases also had a larger shoe size (mean difference 0.4 [0.1, 0.7] UK sizes, p = 0.009) and increased BMI (mean difference 2.2 [1.3, 3.1] kg/m, p < 0.001). Conclusion: Individuals with unexplained HBM have an excess of clinical characteristics associated with skeletal dysplasia and their relatives are commonly affected, suggesting many may harbour an underlying genetic disorder affecting bone mass. [ABSTRACT FROM AUTHOR]

Introduction: To explore physiotherapists' perceptions of mechanisms to explain observed variation in early postoperative practice after hip fracture surgery demonstrated in a national audit. Methods: A qualitative semi-structured interview study of 21 physiotherapists working on orthopaedic wards at 7 hospitals with different durations of physiotherapy during a recent audit. Thematic analysis of interviews drawing on Normalisation Process Theory to aid interpretation of findings. Results: Four themes were identified: achieving protocolised and personalised care; patient and carer engagement; multidisciplinary team engagement across the care continuum; and strategies for service improvement. Most expressed variation from protocol was legitimate when driven by what is deemed clinically appropriate for a given patient. This tailored approach was deemed essential to optimise patient and carer engagement. Participants reported inconsistent degrees of engagement from the multidisciplinary team attributing this to competing workload priorities, interpreting 'postoperative physiotherapy' as a single professional activity rather than a care delivery approach, plus lack of integration between hospital and community care. All participants recognised changes needed at both structural and process levels to improve their services. Conclusion: Physiotherapists highlighted an inherent conflict between their intention to deliver protocolised care while allowing for an individual patient-tailored approach. This conflict has implications for how audit results should be interpreted, how future clinical guidelines are written, and how physiotherapists are trained. Physiotherapists also described additional factors explaining variation in practice which may be addressed through increased engagement of the multidisciplinary team and resources for additional staffing and advanced clinical roles. [ABSTRACT FROM AUTHOR]

Summary: Accurate patient risk perception of adverse health events promotes greater autonomy over, and motivation towards, health-related lifestyles. Introduction: We compared self-perceived fracture risk and 3-year incident fracture rates in postmenopausal women with a range of morbidities in the Global Longitudinal study of Osteoporosis in Women (GLOW). Methods: GLOW is an international cohort study involving 723 physician practices across ten countries (Europe, North America, Australasia); 60,393 women aged ≥55 years completed baseline questionnaires detailing medical history and self-perceived fracture risk. Annual follow-up determined self-reported incident fractures. Results: In total 2,945/43,832 (6.8 %) sustained an incident fracture over 3 years. All morbidities were associated with increased fracture rates, particularly Parkinson's disease (hazard ratio [HR]; 95 % confidence interval [CI], 3.89; 2.78-5.44), multiple sclerosis (2.70; 1.90-3.83), cerebrovascular events (2.02; 1.67-2.46), and rheumatoid arthritis (2.15; 1.53-3.04) (all p < 0.001). Most individuals perceived their fracture risk as similar to (46 %) or lower than (36 %) women of the same age. While increased self-perceived fracture risk was strongly associated with incident fracture rates, only 29 % experiencing a fracture perceived their risk as increased. Under-appreciation of fracture risk occurred for all morbidities, including neurological disease, where women with low self-perceived fracture risk had a fracture HR 2.39 (CI 1.74-3.29) compared with women without morbidities. Conclusions: Postmenopausal women with morbidities tend to under-appreciate their risk, including in the context of neurological diseases, where fracture rates were highest in this cohort. This has important implications for health education, particularly among women with Parkinson's disease, multiple sclerosis, or cerebrovascular disease. [ABSTRACT FROM AUTHOR]

To meet the needs of future closed fuel cycles, the complete recovery of minor actinides, including neptunium, may be required. Neptunium can be fully recovered by modifications to the Plutonium URanium Extraction (PUREX) process but this requires careful control of the Np(V)-(VI) redox reaction in the first solvent extraction contactor to avoid losses to the highly active aqueous raffinate, as occurs in current reprocessing plants. As part of the on-going development of an Advanced PUREX process we report a series of solvent extraction experiments aimed at optimizing neptunium recovery in a process that is based on centrifugal contactors as the extraction equipment. Suitable experimental conditions for Np(V) oxidation were identified through simple stirred 2-phase experiments and single stage mini-centrifugal contactor experiments. A U/Np-active proof-of-principle flowsheet test in a multi-stage centrifugal contactor cascade then demonstrated > 99% extraction of neptunium, thus suggesting the aims for neptunium recovery in advanced fuel cycles can be met by an Advanced PUREX process. [ABSTRACT FROM PUBLISHER]

The fast and efficient development and application of reliable models with appropriate degree of detail to predict the behavior of fragrance aerosols are challenging problems of high interest to the related industries. A generic modeling template for the systematic derivation of specific fragrance aerosol models is proposed. The main benefits of the fragrance spraying template are the speed-up of the model development/derivation process, the increase in model quality, and the provision of structured domain knowledge where needed. The fragrance spraying template is integrated in a generic computer-aided modeling framework, which is structured based on workflows for different general modeling tasks. The benefits of the fragrance spraying template are highlighted by a case study related to the derivation of a fragrance aerosol model that is able to reflect measured dynamic droplet size distribution profiles for limonene. [ABSTRACT FROM AUTHOR]

Introduction Hip fractures are devastating injuries which incur high healthcare costs. Despite national standards and guidelines, there is substantial variation in hospital delivery of hip fracture care and in patient outcomes. This study aimed to understand organisational processes that facilitate successful delivery of hip fracture services. Method Forty qualitative interviews were conducted with healthcare professionals involved in delivering hip fracture care at four English hospitals. Interview data were supplemented with documentary analysis of 23 anonymised British Orthopaedic Association hospital-initiated peer-review reports of services. Data were analysed thematically, with themes transposed onto key components of the care pathway. Results We identified multiple aspects of service organisation that facilitated good care delivery. At admission, standardisation of training in nerve block administration impacted care delivery. During hospital stays, service delivery was improved by integrated, shared-care between orthopaedics and orthogeriatrics, and by strategies to improve trauma list efficiency. Adequately staffed orthogeriatric services and the 'right' skills and seniority mix were important to holistic care provision. Placing patients on designated hip fracture wards concentrated staff expertise. Collaborative working was achieved through multi-disciplinary team (MDT) meetings between key staff, protocols and care pathways that defined roles and responsibilities, MDT documentation, 'joined-up' IT systems within hospitals and with primary care, and shared working spaces such as shared offices and onwards. Trauma and hip fracture coordinators organised care processes and provided a valuable central point of contact within teams. Nominated leads, representing diverse specialties, worked together in MDT planning meetings to develop joint protocols, establish audit priorities, and agree shared goals. Routine, comprehensive monitoring and evaluation of service delivery, with findings shared throughout the MDT, was beneficial. Conclusion Our study has characterised potentially modifiable elements of successful hip fracture service delivery. Findings are intended to help services overcome organisational barriers towards delivery of high-quality hip fracture services. [ABSTRACT FROM AUTHOR]

Introduction The National Hip Fracture Database (NHFD) report that length of stay (LOS) fell (from 19.7 to 16.9 days) in the first year of the COVID-19 pandemic, as patients, families, cares, and staff in health and social care responded to this challenge. This analysis examines trends in Wales where LOS can be profiled very completely as it predominantly remains within a single health board. Method We used data from the NHFD www.nhfd.co.uk to define pre-pandemic LOS (in the year to 1st March 2020) and compare this with the following 18 months. We set figures for all 12 hospitals in Wales against the changes in service organisation which each reported to the NHFD's 2020 Facilities Survey, and against the local incidence of COVID-19 among their hip fracture patients. Results Monthly LOS fell markedly at the pandemic's onset; the national figure falling 8.3 days (from 31.2–22.9 days) between February and June 2020. Overall LOS in Wales fell by 1.6 days across the year as a whole, but this ranged from a fall of 6.3 days in one hospital to a rise of 4.5 days in another. Five hospitals reported a rise in LOS. These hospitals had either never had orthogeriatric support, or lost this to COVID-19 duties, they did not achieve the initial fall in LOS in response to the pandemic, and they reported pressures with 'outliers' after the first wave. Unlike other units in Wales they cited problems with workload, particularly in terms of physiotherapy. Discussion NHFD data provide a detailed picture of hospitals' response to the COVID-19 pandemic, and allow us to examine service factors underpinning their resilience in the face of this challenge. More detailed work should be carried out for the 150 hospitals in England using the same sources of data. [ABSTRACT FROM AUTHOR]

Introduction Older adults who sustain a hip fracture require complex multidisciplinary care, which can challenge organisational structures within hospitals. Despite standards and guidelines, substantial variation remains in hip fracture care delivery across the UK. We aimed to determine which hospital-level organisational factors predict adverse patient outcomes in the post injury period. Method A cohort of 178,757 patients aged 60+ years in England and Wales (2016–19) who sustained a hip fracture was examined. Patient-level Hospital Episodes Statistics, National Hip Fracture Database, and mortality data were linked to metrics from 18 hospital-level organisational audits/reports/series. Multilevel models determined the organisational factors, independent of patient case-mix, associated with three patient outcomes: length of hospital stay (LOS), 30-day all-cause mortality, and emergency 30-day readmission. Results Overall LOS was mean 21 days (standard deviation, 20); 13,126 (7.3%) died within 30-days; and 25,239 (15.3%) were readmitted. 25 organisational factors independently predicted LOS: for example, a hospital's ability to promptly mobilise ≥90% of patients was associated with a 2-day (95%CI:1.3–2.7) shorter LOS, and hospitals where all patients received orthogeriatric assessment within 72 hours of admission had mean 1.5-day (95%CI:0.6–2.3) shorter LOS. Ten organisational factors independently predicted 30-day mortality: providing prompt surgery (≤36 hours from admission) to >80% patients was associated with the same 10% reduction in mortality (95%CI:4–15%), as was discussion of 'patient experience' feedback at clinical governance meetings (95%CI:5–15%). Nine organisational factors independently predicted readmission: knowledge of time from discharge to start of community therapy was associated with 17% (95%CI:9–24%) lower readmission rates. Organisational delivery of clinical governance, surgery, and physiotherapy were associated with all outcomes. Conclusion Multiple, potentially modifiable, organisational factors are associated with important patient outcomes post-hip fracture. These factors, if causal, indicate auditable components of hospital care where interventions can be targeted to reduce variability in hip fracture care delivery, to improve patient outcomes. [ABSTRACT FROM AUTHOR]

Dextrose equivalent (DE) value is the most common parameter used to characterize the molecular weight of maltodextrins. Its theoretical value is inversely proportional to number average molecular weight ( Mn), providing a theoretical basis for correlations with physical properties important to food manufacturing, such as: hygroscopicity, the glass transition temperature, and colligative properties. The use of freezing point osmometry to measure DE and Mn was assessed. Measurements were made on a homologous series of malto-oligomers as well as a variety of commercially available maltodextrin products with DE values ranging from 5 to 18. Results on malto-oligomer samples confirmed that freezing point osmometry provided a linear response with number average molecular weight. However, noncarbohydrate species in some commercial maltodextrin products were found to be in high enough concentration to interfere appreciably with DE measurement. Energy dispersive spectroscopy showed that sodium and chloride were the major ions present in most commercial samples. Osmolality was successfully corrected using conductivity measurements to estimate ion concentrations. The conductivity correction factor appeared to be dependent on the concentration of maltodextrin. Equations were developed to calculate corrected values of DE and Mn based on measurements of osmolality, conductivity, and maltodextrin concentration. This study builds upon previously reported results through the identification of the major interfering ions and provides an osmolality correction factor that successfully accounts for the influence of maltodextrin concentration on the conductivity measurement. The resulting technique was found to be rapid, robust, and required no reagents. [ABSTRACT FROM AUTHOR]

A female patient with diet-controlled Type 2 diabetes mellitus, presented with disseminated malignancy. She had a 15-year history of a diabetic foot ulcer, which was subsequently found to be an amelanotic malignant melanoma. She had recently received immunosuppressive treatment for an episode of nephrotic syndrome secondary to focal segmental glomerulosclerosis. This case raises two important points. Firstly, whether non-healing diabetic foot ulcers should be biopsied, and secondly, whether the spread of the malignant melanoma was precipitated by immunosuppressive treatment. Diabet. Med. 21, 924–927 (2004) [ABSTRACT FROM AUTHOR]

Objective To explore physiotherapists' perceptions of mechanisms to explain observed variation in early postoperative practice after hip fracture surgery demonstrated in a national audit. Methods A qualitative semi-structured interview study of 21 physiotherapists working on orthopaedic wards at 7 hospitals with different durations of physiotherapy during a recent audit. Thematic analysis of interviews drawing on Normalisation Process Theory to aid interpretation of findings. Results Four themes were identified: achieving protocolised and personalised care; patient and carer engagement; multidisciplinary team engagement across the care continuum; and strategies for service improvement. Most expressed variation from protocol was legitimate when driven by what is deemed clinically appropriate for a given patient. This tailored approach was deemed essential to optimise patient and carer engagement. Participants reported inconsistent degrees of engagement from the multidisciplinary team attributing this to competing workload priorities, interpreting 'postoperative physiotherapy' as a single professional activity rather than a care delivery approach, plus lack of integration between hospital and community care. All participants recognised changes needed at both structural and process levels to improve their services. Conclusion Physiotherapists highlighted an inherent conflict between their intention to deliver protocolised care while allowing for an individual patient-tailored approach. This conflict has implications for how audit results should be interpreted, how future clinical guidelines are written, and how physiotherapists are trained. Physiotherapists also described additional factors explaining variation in practice which may be addressed through increased engagement of the multidisciplinary team and resources for additional staffing and advanced clinical roles. [ABSTRACT FROM AUTHOR]

Diglycolamide extractants (DGAs) are playing an important role for many of aqueous separation processes under development for the advanced nuclear fuel cycle. This family of ligands exhibits excellent extracting and resistant properties, with TODGA (N,N,N′,N′-tetraoctyldiglycolamide) being a particularly successful extractant studied intensively in recent decades. Nowadays, the main issues for TODGA-based solvents are related to the understanding and simulation of the radiolytic degradation under realistic conditions, which is limiting aspect for the development of an advanced aqueous nuclear separation process. In that sense, in this work, TODGA ligand stability, solvent composition and performance were evaluated considering the effect of metal complexation under gamma radiation. For that, the irradiation of a TODGA solvent in the presence of Eu metal was carried out, varying the ligand/metal ratio. The goal was to not only study TODGA degradation using HPLC–MS technique but also to identify and quantify its degradation compound under these experimental conditions. The results revealed a protection of TODGA molecules due to metal ion complexation, with no observed changes in the degradation pathway, as confirmed by the quantification of formed degradation compounds. [ABSTRACT FROM AUTHOR]

Background: Non-communicable chronic disease is a major contributor to morbidity and mortality with potentially modifiable lifestyle factors. In women, the menopausal transition modifies women's risk of chronic disease, and pregnancy-related complications have been highlighted as female-specific risk factors. Later reproductive years, before onset of menopause, may represent a window of opportunity for promotion of lifestyle modifications. The aim of this scoping review is to investigate which interventions promoting lifestyle modifications in women of later reproductive years may influence cardiometabolic and bone disease. Methods: A search of three electronic databases (PubMed, Embase, CINAHL) in the English language was performed in January 2024. Eligible studies included women aged 40–55 participating in interventions focusing on lifestyle modification. Studies reporting outcomes related to cardiometabolic disease, bone disease or body composition were eligible for inclusion. Results: Improvements in body composition occurred following interventions focusing on aerobic physical activity. Interventions focusing on health promotion and education, incorporating both dietary and physical activity modifications, prevented weight gain and improved cardiometabolic outcomes. Interventions incorporating elements of behavioural theories enhanced patient-motivated lifestyle modifications, with effects on body composition and cardiometabolic outcomes. Conclusions: Lifestyle modifications in later reproductive years have the potential to influence cardiometabolic and bone disease. Our findings reinforce the benefits of regular aerobic physical activity, as well as health education, for improving body composition and lipid profile. This information could contribute to the development of clinical guidelines for the prevention of chronic disease. [ABSTRACT FROM AUTHOR]

Significant recent discoveries of a large group of high-pressure (HP) minerals are reviewed. These minerals can be classified into two genetic types: those formed in shocked meteorites and impact craters and those formed under static P-T conditions and found as inclusions in diamonds. Of particular interest are the HP-polymorphic modifications of minerals such as olivine, ilmenite, ulvöspinel, wollastonite, and feldspars. Some examples include asimowite, poirierite, ohtaniite, liuite, wangdaodeite, tschaunerite, breyite, davemaoite, lingunite, and liebermannite. Special attention is also devoted to new dense hydrous silicates, which show much better stability than other known hydrous minerals to act as water reservoirs in the early stage of Earth's geological history. The crystal structures and compositions of these new HP-minerals provide valuable insights into the complex petrology of deep geospheres, otherwise not obtainable in laboratory experiments. Using such a rich database, further steps became appropriate and possible toward the directions of a more advanced knowledge of evolution, composition, and structure of Earth. [ABSTRACT FROM AUTHOR]

The discovery is reported of a timber from North Ferriby here interpreted as a piece of boat-planking and therefore the fourth boat-find from that intertidal site. The implications of its radiocarbon age are discussed. Although only a small fragment, the find has some highly significant features and it is argued that it is a piece of a sheerstrake of a boat, conceivably of a late version of the Ferriby-type hitherto represented by the three examples dated to the second millennium B.C. On the strength of the arguments put forward the first author has incorporated key-features into the hypothetical design for a complete Ferriby boat recently developed in collaboration with J. F. Coates. [ABSTRACT FROM AUTHOR]

On the 29 July 1984 archaeologists engaged in a survey of the later Prehistoric and Romano-British landscape around Holme-on-Spalding Moor in East Yorkshire visited land at Hasholme which was being drained. Examination of the drainage works led to the discovery fragments of a substantial logboat amongst timbers which had been removed from the fenland by the contractors after fouling their mole drainer. These fragments were rescued and their findspot (SE S22326 ) identified by the workmen. An excavation was organized by the first author in conjunction with Hull City Museums, to examine the remainder q/the vessel, to investigate its context and establish its date. The spectacular and substantially intact remains o fan oak logboat were located, excavated and recorded 'in situ' in co-operation with a team from the Archaeological Research Centre of the National Maritime Museum under the direction of the second author. The boat was raised and taken to the National Maritime Museum for study before being returned to Hull for conservation and permanent display. Post-excavation research demonstrates that the late Iron Age logboat is unique both in its preservation and in some of its constructional features. An examination of its context allows conclusions to be drawn about the changing environment of the area from the beginning of the fourth millennium B.C. to the first millennium A.D., and provides important new information about the coastline of the Humber area during the Iron Age. A tree-ring study has produced a new dendrochronological sequence for Eastern England for the years 699 to 323 B.C. [ABSTRACT FROM AUTHOR]

The aim of this study was to examine mechanisms of growth in different tissue compartments of the ventricular myocardium of prenatal human hearts. To this end, stereological methods were applied in order to estimate tissue volumes and total numbers of myocyte, connective tissue and endothelial nuclei in hearts collected after death at between 16 and 35 weeks of gestation. Volumes of tissue compartments were obtained after multiplying volume densities (estimated by test-point counting) by ventricular volumes (estimated from ventricular mass and tissue density). Absolute numbers of nuclei were calculated in similar fashion from corresponding nuclear packing densities (estimated using physical disectors). The volumes of all three tissue compartments increased linearly over the period of gestation examined, and in each case, the increase in tissue volume appeared to be due entirely to proliferation. Numbers of all three types of nuclei increased linearly whilst tissue volumes per nucleus remained constant. The net rate of production of myocyte nuclei was 35 x 10(7) per week (2.1 million nuclei per hour). The net rate of production of connective tissue nuclei was 12 x 10(7) per week (0.7 million nuclei per hour) and that for endothelial cell nuclei was 5.1 x 10(7) per week (0.3 million nuclei per hour). Predictions are made about the postnatal ages at which adult ratios of different nuclear types might be attained. [ABSTRACT FROM AUTHOR]

Aluminum has been shown to significantly enhance the water incorporation capacity of orthoenstatite (OEn), but the incorporation mechanisms remained to be clarified. We performed a comprehensive one- and two-dimensional 1H, 29Si and 27Al NMR study on four hydrous aluminous OEn samples containing 1–8 wt% Al2O3 synthesized at 1.5 GPa and 900 °C to clarify the issue. The combined 1H MAS and static (non-spinning) NMR, 1H double-quantum and triple-quantum MAS NMR, and 27Al→1H CP MAS NMR and HETCOR results, in particular, unambiguously revealed that a large part of the incorporated water are present as proton pairs in Mg vacancies adjacent to Al, with one proton of each pair for the dominant proton pairs exhibiting significantly weaker hydrogen bonding than those in Al-free OEn. Proton pairs in Mg vacancies remote from Al are minor or absent for samples with 4–8 wt% Al2O3, and more abundant for a sample with 1 wt% Al2O3. Isolated protons due to coupled substitutions of Al + H for 1Si and 2Mg (both with weak hydrogen bonding) were also detected, but are less abundant than hitherto considered. The observed NMR peaks match well with those predicted for the corresponding OH defect models from our first-principles calculations. Thus, the enhancement of water solubility by Al for OEn are due to not only coupled substitutions of Al + H for 1Si and 2Mg, but also interactions of Al with proton pairs in Mg vacancies. These mechanisms may also be important in other nominally anhydrous aluminous silicate minerals. [ABSTRACT FROM AUTHOR]

We performed first-principles calculations on the energy, and NMR and polarized infrared (IR) spectra for anhydrous and hydrous aluminous orthoenstatite (OEn) models to help clarify the incorporation mechanisms of Al and OH defects in OEn. Our calculations revealed that proton pairs in M2 vacancies ((2H)M2) adjacent to a tetrahedral Al (AlIV) are energetically more favorable than those remote from Al, and may contribute to the observed correlated 1H NMR peaks near 3.7 and 8.0 ppm, and IR bands near 3550–3570 and 3066 cm−1 (A4 band) for aluminous OEn. Coupled substitutions of AlVI (octahedral Al) + H for 2Mg were found to adopt multiple configurations, and may contribute to the observed IR bands near 3520, 3475 and 3320 cm−1. Coupled substitution of AlIV + H for 1Si may contribute to the observed IR band near 3380–3400 cm−1. 4H in SiB vacancies ((4H)SiB) adjacent to an AlVI were found to be energetically more favorable than those remote from Al, and may be the origin for an IR band observed near 3600–3620 cm−1. These results allow the incorporation mechanisms of water in synthetic and natural aluminous orthopyroxenes to be deciphered from the available NMR and IR data, and suggest that both (2H)M2 defects associated with Al and simultaneous coupled substitutions of Al + H for 2Mg and 1Si contribute to the observed correlation between Al and water incorporation, and the nearly unity AlIV/AlVI ratio. (4H)SiB defects associated with Al may also be present in some synthetic OEn and mantle-derived orthopyroxene. [ABSTRACT FROM AUTHOR]

Ethnopharmacological relevance: Natural substance geraniol has anti-inflammatory and antioxidant qualities. It may be used to treat metabolic diseases such as diabetes, obesity, and cardiovascular illnesses. Innovations in nanoformulations enhance geraniol's absorption, stability, and targeted distribution, augmenting its therapeutic effectiveness and mitigating side effects, despite the limits of traditional treatment. Aim of the review: The therapeutic potential of geraniol in the management of metabolic disorders such as diabetes, obesity, neuroinflammation, and cardiovascular disease is examined in this review. It highlights the anti-inflammatory, antioxidant, and lipid-lowering qualities of geraniol as well as the potential for nanoformulations to increase bioavailability and therapeutic efficacy. Materials and methods: A collection of pertinent research articles about the potential of geraniol in metabolic illnesses, including obesity, type 2 diabetes, as well as cardiovascular diseases, was compiled from PubMed, Scopus, and Google Scholar. Terms such as "metabolic syndrome," "antioxidant," "anti-inflammatory," "geraniol," and "nanoformulations" were employed. Google Patents were also examined in order to offer insights into current and upcoming research. Results: The potential of geraniol to treat metabolic disorders, including obesity, diabetes, hyperlipidemia, and cardiovascular illnesses, is thoroughly reviewed in this article. Recent research has demonstrated the lipid-lowering, antioxidant, and anti-inflammatory properties of geraniol as well as its ability to improve endothelial function and reduce oxidative stress in preclinical animals. The paper delves into the various nanoformulations, including liposomes, nanoparticles, and nanoemulsions, which enhance geraniol's therapeutic efficacy and bioavailability, making it a viable option for managing metabolic syndrome. Conclusion: The antioxidant, anti-inflammatory, and lipid-lowering qualities of geraniol make it a promising treatment for metabolic diseases. Its bioavailability along with therapeutic efficacy are increased by nanoformulations, which makes it a compelling option for the treatment of conditions such as neuroinflammation, diabetes, and obesity. [ABSTRACT FROM AUTHOR]

Osteoporosis (OP) is the most prevalent metabolic bone disease and an important postmenopausal consequence. This study aimed to investigate the effects of morin, a flavonoid with beneficial properties, on ovariectomy‐induced OP. Animals were ovariectomized (OVX) and treated with different doses of morin (15, 30, and 45 mg/kg/day) or estradiol (10 μg/kg/day) for 10 weeks by gavage. Then bone histo‐stereology, bone‐related biochemical indicators, and gene and protein levels of autophagy and apoptosis‐related markers were analyzed. In comparison to controls, OVX significantly decreased the number of osteoblasts (5.78 × 106 vs. 1.66 × 106) and osteocytes (32.55 × 106 vs. 11.92 × 106), whereas increasing the number of osteoclasts (83.38 × 103 vs. 392.1 × 103). Moreover, OVX caused a remarkable decrease in bone structures and Ca, P, and estradiol levels while increasing ALP and OC (p < 0.001). The administration of 45 mg/kg/day morin restored the effects of OP on bone histomorphology and biochemical markers (p < 0.05). Further studies revealed that morin caused a 7.1% and 36.6% decrease in the bone level of LC3 and BECN1 proteins, respectively, compared to the OVX group. Also, morin caused a significant decrease of 47.4% in the CASP3 level and a significant increase of 23.6% in the BCL‐2 level compared to OVX animals (p < 0.001). The present findings showed that morin is potentially able to improve the bone‐related histomorphological and biochemical changes caused by osteoporosis, which is probably attributed to the suppression of apoptosis‐ and autophagy‐caused cell death. [ABSTRACT FROM AUTHOR]

Background: Postmenopausal osteoporosis (PMOP) is a serious condition that affects elderly individuals. Our previous study revealed that Yigu decoction (YGD) effectively improved bone mineral density (BMD) in elderly individuals, but the mechanism underlying this effect remains unclear. In this study, we investigated the relationships among YGD, microRNAs (miRNAs), and bone metabolism by assessing the effects of YGD on the miRNA levels in patient plasma to provide a scientific basis for treating PMOP with YGD. Methods: In this clinical trial, 60 patients were randomly assigned to the YGD group or the control group (ratio of 1:1) and treated for 3 months. The primary outcome measure was BMD, and the secondary outcome measures included plasma miRNA levels, visual analogue scale (VAS) scores, alkaline phosphatase (ALP) levels, anti-tartrate acid phosphatase (TRACP-5b) levels and traditional Chinese medicine (TCM) syndrome scores. We assessed the regulatory roles of miRNAs in PMOP patients by analysing publicly available data from the Gene Expression Omnibus (GEO) database. Bioinformatics methods were also used to explore the mechanism by which YGD regulates miRNAs that are involved in bone metabolism. Results: Compared with those before treatment, the BMD, ALP levels, TRACP-5b levels, TCM syndrome scores and VAS scores improved in both groups after 3 months of treatment (P < 0.05). A total of 82 miRNAs differed between the groups. After analysing data from the GEO database, we confirmed that miR-133a-3p is the key molecule that mediates the effects of YGD intervention on PMOP. GO analysis of key genes suggested that gene enrichment was more pronounced in response to hormones, cellular response to growth factor stimulation, and positive regulation of physiological and metabolic processes. KEGG analysis revealed that these genes were enriched mainly in the PI3K-Akt, FOXO, and JAK-STAT pathways and other pathways. The results of the protein‒protein interaction (PPI) network analysis revealed that epidermal growth factor receptor (EGFR), Insulin-like growth factor 1 (IGF-1), Caveolin-1 (Cav-1) and others were core proteins. Conclusion: This study demonstrated that YGD is beneficial in the treatment of PMOP, ameliorating clinical symptoms and bone turnover indices. Moreover, the inhibition of miR-133a-3p expression may be the key mechanisms by which YGD regulates bone metabolism in the treatment of PMOP, although YGD regulates bone metabolism in a multitarget and multipathway manner. [ABSTRACT FROM AUTHOR]

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DGA (diglycolamide) ligands show a different extraction behavior of trivalent metal ions by changing the branching alkyl chain length as well as the branching at the methylene position. There are no studies of these factors on the extraction efficiency of these DGA derivatives for the extraction of tetravalent actinides. We have evaluated four different DGA derivatives for the extraction of Np, Pu, and Th from molecular diluents. The n-butyl derivative shows enhanced extraction efficiency and branching gives rise to a reduction in the extraction efficiency of tetravalent ions. The distribution ratios are higher in pure octanol than in a mixture of 30% octanol and 70% n-dodecane. This behavior is in marked difference to that of the extraction of trivalent ions where the addition of an alcohol generally decreases the distribution ratio of trivalent ions due to the ligand-modifier intercation, poor aggregation or micelle formation tendency of DGAs in polar solvents. This suggests that micelle-mediated extraction may not be the dominating factor for the extraction of tetravalent metal ions. Slope analysis suggests the involvement of only two DGA molecules in the extracted species suggesting no/poor possibility of micelle formation in the present system. The higher extraction in pure octanol may be due to a better solubility of the extracted complexes in this polar medium compared to the mixture of octanol and n-dodecane. The water and acid uptake, the back extraction, and the radiation stability of the solvent systems were also investigated. DFT studies were performed to get a better insight into the extraction and complexation of the different DGA solvent systems. [ABSTRACT FROM AUTHOR]

Background: Evidence shows that the total flavonoids of Rhizoma Drynariae (TFRD) can improve bone mineral density (BMD). However, there is no evidence to summarize the improvement of biochemical indicators of bone metabolism (BIBM). Methods: The PubMed, Web of Science, Cochrane Library, Embase, Chinese National Knowledge Infrastructure (CNKI), Wanfang Database, Chongqing VIP Information Database (VIP) and SinoMed were searched from inception to 6 May 2024. The final included studies performed meta-analyses using RevMan 5.3. Results: Nine randomized controlled trials (RCTs) were ultimately included. The TFRD group had higher bone gla protein (BGP) and type I procollagen-N-propeptide (PINP) compared to theOther therapies (WMD: 5.11; 95% CI: 3.37, 6.84; p < 0.00001; WMD: 13.89; 95% CI: 11.81, 15.97; p < 0.00001). The tartrate-resistant acid phosphatase (TRACP) decreased significantly (WMD: -1.34; 95% CI: -1.62, -1.06; p < 0.00001). The alkaline phosphatase (ALP) increased significantly (WMD: 7.47; 95% CI: 6.29, 8.66; p < 0.00001). There were no significant differences in serum calcium (SC) or serum phosphorus (SP) levels between the TFRD and control groups (WMD: 0.08; 95% CI: -0.04, 0.20; p = 0.17; WMD: 0.02; 95% CI: -0.02, 0.05; p = 0.36). Conclusion: TFRD can stimulate bone formation and prevent bone resorption in osteoporosis (OP) patients, but it has no effect on SC and SP. Systematic Review Registration: https://www.crd.york.ac.uk/PROSPERO/. [ABSTRACT FROM AUTHOR]

Purpose: Opportunistic osteoporosis screening, conducted during routine medical examinations such as chest computed tomography (CT), presents a potential solution for early detection. This study aims to investigate the feasibility of utilizing radiomics technology based on chest CT images to screen for opportunistic osteoporosis. Methods: This Study is a Multicenter Retrospective Investigation. Relevant clinical data, including demographics and DXA results, would be collected for each participant. The radiomics analysis in this study focuses on the extraction of features from the 11th or 12th thoracic vertebral bodies from chest CT images. SVM machine learning models would be trained using these radiomic features, with DXA results as the ground truth for osteoporosis classification. Results: In the training group, Clinical models had an accuracy of 0.684 and an AUC of 0.744, Radiomics models had an accuracy of 0.828 and an AUC of 0.896, Nomogram models had an accuracy of 0.839 and an AUC of 0.901. In the internal validation group, Clinical models had an accuracy of 0.769 and an AUC of 0.829, Radiomics models had an accuracy of 0.832 and an AUC of 0.892, Nomogram models had an accuracy of 0.839 and an AUC of 0.918. In the external validation group, Clinical models had an accuracy of 0.715 and an AUC of 0.741, Radiomics models had an accuracy of 0.777 and an AUC of 0.796, Nomogram models had an accuracy of 0.785 and an AUC of 0.807. In all three datasets, the Nomogram model exhibited a statistically significant difference in screening effectiveness compared to the clinical models. Conclusion: Our research demonstrates that by leveraging radiomics features extracted from a single thoracic spine using chest CT, and incorporating these features with patient basic information, opportunistic screening for osteoporosis can be achieved. [ABSTRACT FROM AUTHOR]

Objectives: Anti‐resorptive agents have been linked to the development of MRONJ in patients undergoing dental surgical procedures. This survey aims to explore the level of knowledge and experience of Italian Society of Periodontology and Implantology members in the management of patients treated with anti‐resorptive agents and with the risk of developing MRONJ. Materials and Methods: An 18‐item questionnaire was submitted by e‐mail to the SIdP members. Statistical analyses were carried out. Continuous variables were described as mean ± standard deviation (SD) or median, and first and third quartile according to distribution's normality. Normality of data was checked with Shapiro–Wilk test. Results: Four hundred and fifty‐one questionnaires were returned by e‐mail (32%). Most of the respondents were private practitioners (81.8%). Only 47.7% declared to be highly confident in managing patients on anti‐resorptive therapy while 92.5% reported to have performed tooth extractions and 52.3% implant surgery in patients under anti‐resorptive therapy for osteometabolic disorders. One or more MRONJ‐affected patients were encountered by 63.2% of the respondents. Conclusions: This survey highlights the need to develop a "dedicated" program both for dentists and prescribers to improve the level of cooperation and to increase the level of awareness of patients treated with anti‐resorptive agents. [ABSTRACT FROM AUTHOR]

Recent evidence suggests an association between age‐related osteoporosis and cellular senescence in the bone; however, the specific bone cells that play a critical role in age‐related osteoporosis and the mechanism remain unknown. Results revealed that age‐related osteoporosis is characterized by the loss of osteoblast Men1. Osteoblast‐specific inducible knockout of Men1 caused structural changes in the mice bones, matching the phenotypes in patients with age‐related osteoporosis. Histomorphometrically, Men1‐knockout mice femurs decreased osteoblastic activity and increased osteoclastic activity, hallmarks of age‐related osteoporosis. Loss of Men1 induces cellular senescence via mTORC1 activation and AMPK suppression, rescued by metformin treatment. In bone morphogenetic protein‐indued bone model, loss of Men1 leads to accumulation of senescent cells and osteoporotic bone formation, which are ameliorated by metformin. Our results indicate that cellular senescence in osteoblasts plays a critical role in age‐related osteoporosis and that osteoblast‐specific inducible Men1‐knockout mice offer a promising model for developing therapeutics for age‐related osteoporosis. [ABSTRACT FROM AUTHOR]

The selective functionalization of 1,3-bis(boronic) esters holds the potential for creating diverse molecular structures, particularly through the late-stage functionalization of the remaining C–B bond. By employing distinct organometallic reagents, we have developed a method for regiodivergent alkynylation of 1,3-bis(boronic) esters, facilitated by unique chelation patterns. Notably, this methodology effectively overcomes limitations commonly encountered in radical chemistry, which generates only monoselective downstream targets. Furthermore, the compounds synthesized through this approach can serve as significant building blocks, contributing to the construction of molecular complexity. [ABSTRACT FROM AUTHOR]