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Abstract Background ChatGPT has gained widespread attention for its ability to understand and provide human-like responses to inputs. However, few works have focused on its use in Orthopedics. This study assessed ChatGPT’s performance on the Orthopedic In-Service Training Exam (OITE) and evaluated its decision-making process to determine whether adoption as a resource in the field is practical. Methods ChatGPT’s performance on three OITE exams was evaluated through inputting multiple choice questions. Questions were classified by their orthopedic subject area. Yearly, OITE technical reports were used to gauge scores against resident physicians. ChatGPT’s rationales were compared with testmaker explanations using six different groups denoting answer accuracy and logic consistency. Variables were analyzed using contingency table construction and Chi-squared analyses. Results Of 635 questions, 360 were useable as inputs (56.7%). ChatGPT-3.5 scored 55.8%, 47.7%, and 54% for the years 2020, 2021, and 2022, respectively. Of 190 correct outputs, 179 provided a consistent logic (94.2%). Of 170 incorrect outputs, 133 provided an inconsistent logic (78.2%). Significant associations were found between test topic and correct answer (p = 0.011), and type of logic used and tested topic (p =

Introduction. Olecranon fractures are common injuries that require surgical intervention for optimal outcomes. Various fixation methods have been described in the literature, including the use of intramedullary proximal ulna screws in combination with tension band augmentation. Limited research has compared this hybrid technique to other established methods of fixation. This study compared complication and reoperation rates between multiple groups. Methods. A retrospective review was conducted on patients with olecranon fractures who underwent internal fixation at a level 1 trauma center between January 1st, 2013, and April 22nd, 2023. Data was collected using CPT codes, and patients were categorized into five groups based on the method of fixation received: no implant, tension band only, locking olecranon plate, intramedullary screw and tension band hybrid, and others. Variables such as patient demographics, Mayo fracture classification, open vs. closed injury, implant type, reoperation rates, and postoperative complications were recorded. Results. A total of 217 patients were included in the study. No difference was found with implant choice and reoperation rate (p=0.461). There was a significant difference found with reoperation and fracture type (p=0.027) and open fracture (p=0.002). Conclusion. The primary findings of this study indicate no significant difference in implant choice and reoperation rates among the various fixation methods used for olecranon fractures. These findings suggest that the hybrid fixation technique, utilizing intramedullary proximal ulna screws in combination with tension band augmentation, is a viable and comparable treatment option when evaluated against other well-documented methods of fixation. This study also reiterates that severity of initial injury is often the most important factor related to poorer outcomes. Further discussion and analysis of the data will provide a comprehensive understanding of implications and recommendations for olecranon fracture fixation.

The primary objective was to evaluate performance of low concentration SDS decellularised porcine pulmonary roots in the right ventricular outflow tract of juvenile sheep. Secondary objectives were to explore the cellular population of the roots over time. Animals were monitored by echocardiography and roots explanted at 1, 3, 6 ( n = 4) and 12 months ( n = 8) for gross analysis. Explanted roots were subject to histological, immunohistochemical and quantitative calcium analysis ( n = 4 at 1, 3 and 12 months) and determination of material properties ( n = 4; 12 months). Cryopreserved ovine pulmonary root allografts ( n = 4) implanted for 12 months, and non-implanted cellular ovine roots were analysed for comparative purposes. Decellularised porcine pulmonary roots functioned well and were in very good condition with soft, thin and pliable leaflets. Morphometric analysis showed cellular population by 1 month. However, by 12 months the total number of cells was less than 50% of the total cells in non-implanted native ovine roots. Repopulation of the decellularised porcine tissues with stromal (α-SMA+; vimentin+) and progenitor cells (CD34+; CD271+) appeared to be orchestrated by macrophages (MAC 387+/ CD163 low and CD163+/MAC 387−). The calcium content of the decellularised porcine pulmonary root tissues increased over the 12-month period but remained low (except suture points) at 401 ppm (wet weight) or below. The material properties of the decellularised porcine pulmonary root wall were unchanged compared to pre-implantation. There were some changes in the leaflets but importantly, the porcine tissues did not become stiffer. The decellularised porcine pulmonary roots showed good functional performance in vivo and were repopulated with ovine cells of the appropriate phenotype in a process orchestrated by M2 macrophages, highlighting the importance of these cells in the constructive tissue remodelling of cardiac root tissues.

Decellularised heart valve roots offer a promising option for heart valve replacement in young patients, having the potential to remodel and repair. Replacement heart valves have to undergo billions of opening and closing cycles throughout the patient's lifetime. Therefore, understanding the effect of cyclic loading on decellularised heart valve roots is important prior to human implantation. The aim of this preliminary study was to investigate the influence of low concentration sodium dodecyl sulphate (SDS) decellularisation treatment on the in vitro real time mechanical fatigue of porcine aortic heart valve roots under physiological real time cyclic loading conditions. This required a specific real time in vitro method to be developed, since previous methods relied on accelerated testing, which is non-physiological, and not appropriate for valve replacement materials that exhibit time dependent characteristics. The effects of the real time fatigue on hydrodynamic function and mechanical properties of the heart valve roots were assessed. The mechanical fatigue of decellularised porcine aortic heart valve roots (n = 6) was assessed and compared to cellular porcine aortic heart valve roots (n = 6) in a modified Real time Wear Tester (RWT) at a physiological frequency and under cyclic pressure conditions for a maximum of 1.2 million cycles. Periodically, the heart valve roots were removed from the RWT to assess the influence of cyclic loading on valve competency (static leaflet closure). At the end of testing further hydrodynamic performance parameters were ascertained, along with determination of leaflet material properties. A real time mechanical fatigue assessment method was developed and applied; with two cellular and two decellularised porcine aortic leaflets in different heart valve roots showing tears in the belly region. The decellularised aortic heart valve roots exhibited comparative functionality to the cellular heart valve roots under in vitro static and pulsatile hydrodynamic conditions. However, the material properties of the decellularised aortic leaflets were significantly altered following cyclic fatigue assessment and showed increases in elastin and collagen phase slopes and ultimate tensile strength compared to the cellular porcine aortic leaflets in the circumferential direction. This preliminary study demonstrated that low concentration SDS decellularised porcine aortic heart valve roots can withstand physiological cyclic deformations up to 1.2 million cycles in a RWT whilst maintaining their overall hydrodynamic function and leaflet mechanical properties. This is the first full report of preclinical mechanical fatigue assessment of decellularised porcine aortic heart valve roots under physiological real time conditions.

Attention has been given to the experience of individuals undergoing assisted reproductive techniques. However, only recent literature has focused on the spiritual journey triggered by such an event and highlighted the nurses and midwives’ roles in the assessment of the spiritual needs of those living with infertility. This study aimed to perform a psychometric test of the factor structure of the Portuguese version of the Spiritual Well-being Questionnaire in a sample of people undergoing assisted reproductive techniques. This descriptive cross-sectional study was conducted between September 2019 and June 2020 on a sample of 104 Portuguese adults attending fertility treatment. An online questionnaire was released on fertility-related websites. A confirmatory factor analysis was conducted on six hypothesized models of the instrument. The findings provided evidence of an adequate internal consistency of the instrument, and the validity and reliability of the oblique four-factor model was confirmed. Spiritual well-being had a significant association with the nature of infertility and a higher score was achieved by participants that perceived religion as very important. This study provides a validated tool for nurses and midwives to assess spiritual well-being and promote an integrated reproductive healthcare approach. Further longitudinal research with bigger samples would provide more evidence of the spiritual needs of people living with this condition.

Healthcare systems produce significant greenhouse gas emissions, raising an important question: should healthcare be treated like any other polluter when it comes to reducing its emissions, or is healthcare special because of its essential societal role? On one hand, reducing emissions is critical to combat climate change. On the other, healthcare depends on emissions to deliver vital services. The resulting tension surrounds an idea of healthcare exceptionalism and leads to the question I consider in this paper: to what extent (if any) should the valuable goals of healthcare form an exception to the burdens of reducing greenhouse gas emissions? The goals of this paper are twofold. One is to think about how to address the issue of healthcare exceptionalism. Second is to discuss the extent of healthcare's climatic responsibilities. I examine two perspectives on healthcare exceptionalism. The first treats a responsibility to reduce emissions and the delivery of healthcare as separate issues, each governed by its own principle. I reject this view, proposing instead that we consider healthcare's environmental responsibilities in conjunction with its essential functions. I defend an "inability to pay" principle, suggesting that while healthcare should indeed contribute to mitigating climate change, its obligations should be constrained by the necessity of maintaining its core goals like protecting health and preventing disease. Healthcare should be treated differently from other sectors, but not to the extent that it is entirely exempt from efforts to reduce emissions., Competing Interests: Declarations. Conflict of interest: No conflicts of interest. This research does not involve any participants., (© 2025. The Author(s).)

Schwarzites are hypothetical carbon allotropes in the form of a continuous negatively curved surface with three-dimensional periodicity. These materials of the future attract interest because of their anticipated large surface area per volume, high porosity, tunable electric conductivity, and excellent mechanical strength combined with light weight. A three-decade-long history attempting schwarzite synthesis from gas-phase carbon atoms went without success. Design of schwarzites is both a digital art and the science of placing tiles of sp 2 -carbon polygons on mathematically defined triply periodic minimal surfaces. The knowledge of how to connect polygons in sequence using the rules of symmetry unlocks paths for the bottom-up synthesis of schwarzites by organic chemistry methods. Schwarzite tiling by heptagons is systematically analyzed and classified by symmetry and topology. For the first time, complete plans for the bottom-up synthesis of many schwarzites are demonstrated. A trimer of heptagons is suggested as the key building block for most synthetic schemes.

Abstract: Puberty is a particularly vulnerable time for individuals with autism spectrum disorder (ASD) during which baseline challenges are exacerbated, functioning often deteriorates, and additional barriers emerge. Specific concerns include increased vulnerability, decreased safety, and increased mood and behavioral disturbances. Youth with ASD need guidance and explicit instruction/skill development on topics such as hygiene/self-care, appropriate sexual activity, and menstruation management. Lack of provider preparation, knowledge, and confidence, along with stigma about the needs and capabilities of individuals with ASD, are major barriers to care. Initiatives to expand the preparation of health care personnel, including nurse practitioners, to provide quality care to individuals with ASD are essential. This article describes the results of a pilot project using a brief, self-guided educational intervention for developing and practicing family nurse practitioners. Before and after viewing the educational module, participants completed author-created surveys assessing their self-perceived knowledge, attitudes, and intent to change practice. Expert analysis of survey items provided face validity. Comparison of mean presurvey and postsurvey responses showed significant increases in self-perceived knowledge, attitudes, and intent to implement practice changes. Lack of confidence was endorsed as the most common remaining barrier to change. Findings indicate that the brief module improved participants' self-reported knowledge, attitudes, and intent to implement practice recommendations. Such interventions can be easily incorporated into nursing education and professional development and are appropriate for dissemination to nurse practitioners working within and outside primary care settings, as well as to related service providers., Competing Interests: Competing interests: The authors report no conflicts of interest., (Copyright © 2024 American Association of Nurse Practitioners.)

Objectives: To determine the number of patients that met classification for antiphospholipid antibody syndrome (APS) after applying the 2023 American College of Rheumatology and the European Alliance for Associations of Rheumatology (ACR/EULAR) classification criteria, to identify reasons patients did not meet the new criteria, and determine the number of patients who were single, double, or triple positive based on laboratory criteria., Methods: A single center, retrospective chart review of patients with APS on anticoagulation managed by ambulatory care clinical pharmacists. Data collected included patient demographics, type of anticoagulation, and clinical and laboratory criteria for APS as defined by the 2023 ACR/EULAR criteria. Data is presented using descriptive statistics., Results: A total of 51 patients previously diagnosed with APS were included. There were 42 patients on warfarin (82.3%), 4 patients on direct oral anticoagulants (19%), 3 patients on low molecular weight heparin (5.8%), and 2 patients on fondaparinux (3.9%). Of the 51 patients, 12 (23.5%) met classification criteria, 33 (64.7%) did not meet classification criteria and 6 (11.7%) had insufficient data. Of the 27 patients that did not meet criteria, 13 patients did not meet the laboratory criteria (39.4%), 6 patients did not meet the clinical criteria (18.2%) and 14 patients did not meet both laboratory and clinical criteria (42.4%). Of the 12 patients that met classification criteria, 2 patients were triple positive (16.7%), 3 were double positive (25%), and 7 were single positive (58.3%)., Conclusions: Results from this study indicate that APS continues to be a complex disease state with challenges in diagnosis and classification. Since only a small number of patients in our clinic continued to meet the classification criteria, opportunities for patient re-evaluation of management strategies at our institution could be considered., Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Objectives: This study assesses the infrastructure and resources surrounding diversity, equity, inclusion, and accessibility (DEIA) efforts in pharmacy education. The objectives were to investigate leadership roles and qualifications, resource commitment, challenges faced, and proudest accomplishments related to DEIA initiatives in colleges and schools of pharmacy., Methods: A 27-question survey was distributed to CEO deans of US colleges and schools of pharmacy. Descriptive statistics were used for data analysis., Results: Of the 48 respondents (33 % response rate), 30 (63 %) indicated they utilized a standing DEIA committee and/or a DEIA leader with varying degrees of their position committed to these initiatives. Most leaders (40 %) indicated moderate to significant, but informal training related to their responsibilities. There was wide variation between both allocated salaries or stipends ($0 to >$140,000) and additional budgeted monies for DEIA activities ($0 - > $50,000). Over 90 % of respondents referenced a commitment to DEIA in various institutional documents, and provided multiple training opportunities to faculty, staff, and in some cases, preceptors. The vast majority (91 %) of programs reported having a relationship with their parent institution regarding DEIA, with varying levels of support., Conclusions: This study provides insights into the landscape of DEIA in pharmacy education. Despite a modest response rate, respondents are representative of the academy highlighting the diversity of DEIA initiatives and leadership approaches across colleges and schools of pharmacy. Further research is needed to explore non-responders' perspectives, assess the impact of DEIA initiatives on educational outcomes and student experiences, and to see how the political landscape since distribution of this survey has changed DEIA initiatives., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Introduction: Smoking prevalence rates in prison are typically four times higher than the rates found within community-based settings, increasing premature mortality. Encouraging smokers to self-administer incentives contingent on abstinence (i.e., self-incentivize) are effective in community-based settings and have the potential to work in an incarcerated population. The present study aims to: gauge the feasibility of- and assess possible effects associated with- encouraging smokers to self-incentivize to increase smoking abstinence., Methods: The study recruited 25 smokers from a UK prison who were attending the prison-based stop smoking service. Participants were randomized to one of three conditions, either: (a) an active control, asked to form a plan to quit smoking (n=5); or to self-incentivize if they had not smoked at all by the end of (b) the week (n=7); or (c) the month (n=13). The study gave no specific options to participants in choosing a self-incentive for a number of reasons (e.g., to enable choice of a self-incentive of sufficient rewarding value within a restrictive setting). Participant eligibility included: (a) aged 18 years or over, (b) able to understand written English, (c) competent to provide informed consent, and (d) were tobacco smokers, smoking on a daily basis. Acceptance and completion assessed feasibility. Chi-square analysis assessed possible effect of the intervention., Results: Twenty five out of 27 smokers who were approached, welcomed the opportunity of further support and completed the baseline questionnaire. At 3-month follow-up, no participants (0/5) in the control condition abstained from smoking. In contrast, three (out of seven, d=1.12) participants who self-incentivized on a weekly basis abstained, and five (out of 13, d=0.83) participants who self-incentivized on a monthly basis abstained at the 3-month follow-up time point. Abstaining is defined as no cigarette smoked within at least the last 28-days via self-report and supported by biochemical verification from a sub-sample of participants (68%; 17/25)., Conclusions: Use of self-incentives alongside behavioral support and cessation medication is feasible and can be delivered at low-cost. Furthermore, the promise seen in this trial suggests a fully powered randomized controlled trial has the potential to increase smoking abstinence in an incarcerated population., (Copyright © 2025 The Authors. Published by Elsevier Inc. All rights reserved.)

Skin carcinoma, which includes basal cell carcinoma (BCC), squamous cell carcinoma (SCC), and melanoma, is influenced by various factors such as genetic predisposition, chemical exposures, immune system imbalances, and ultraviolet (UV) radiation. This review delves into the mechanisms behind the development of these cancers, exploring the therapeutic potential of microbial, plant derived compounds and nanoparticles in advancing skin cancer treatments. Special attention is given to the cytotoxic effects of anti-neoplastic agents from microbial sources on different cancer cell lines, particularly melanoma. Additionally, the review highlights the role of phytochemicals - such as quercetin, resveratrol, and curcumin alongside vitamins, terpenoids, and sulforaphane, in management of skin cancers through mechanisms like apoptosis induction and cell cycle regulation. Recent advancements in nanotechnology-based drug delivery systems, including NP and microemulsion formulations, are also discussed for their enhanced ability to specifically target cancer cells. The diverse roles of NPs in skin cancer therapy, especially in terms of targeted drug delivery and immune modulation, are reviewed. These innovative NPs formulations have showed improved skin penetration and tumor-specific delivery, reduced systemic toxicity and enhanced therapeutic effectiveness., (© 2024 Walter de Gruyter GmbH, Berlin/Boston.)

The purpose of this study was to determine the relationship between triptans (sumatriptan, rizatriptan, and zolmitriptan) and cardiovascular (CV) adverse events with data from the FDA Adverse Event Reporting System (FAERS). FAERS database was used to collect data on triptans from 1997 to 2023. Disproportionality methods were utilized to quantify triptan-associated CV events and to identify the potential risk. The reporting odds ratio was used to identify the risk signals. CV outcomes related to age, sex, clinical results, and other factors were also examined for triptans; 820 reports involving the triptans were recognized as CV adverse events out of total of 12 699 reports that were gathered from on FAERS database. Women reported more CV adverse events with rizatriptan and zolmitriptan as compared to men. The CV adverse event risk was highest among individuals aged 18-64. Clinical outcome analysis showed that sumatriptan carries a higher CV risk than rizatriptan and zolmitriptan, and most deaths and serious cases have been documented for sumatriptan. The patients prescribed sumatriptan or zolmitriptan were at a higher risk of reporting CV events for chest pain and chest discomfort, compared to rizatriptan. This finding may provide support for the clinical observation and risk evaluation of triptan treatment.

Background: Diabetes distress is a common emotional issue for those living with diabetes, which has the potential to negatively impact well-being, management behaviors, and HbA1c levels. These implications have led to diabetes distress becoming an important consideration in diabetes healthcare and management. Nonetheless, discussions remain ongoing on how to best conceptualize this experience. Recent research has attempted to enhance conceptualization by considering the underlying emotional mechanisms that may underpin the highly contextualized experience of diabetes distress. Qualitative insights can further add to these understandings; however, the research in this remit is yet to be systematically reviewed. This review therefore sought to add to the growing body of literature attempting to better conceptualize diabetes distress and the underlying mechanisms that may contribute to this experience. A secondary aim was to leverage this understanding to consider ways to improve patient-healthcare interactions. Methods: A qualitative systematic review and thematic synthesis was undertaken. Eligible studies were identified through PsycINFO, MEDLINE, CINAHL, and EMBASE databases from November 2020 to May 2021. Study quality was assessed using the McMaster Critical Review Form. Results: Nineteen papers were included in the review. The analysis resulted in seven descriptive themes which contributed to three analytical themes: (1) threatened autonomy, (2) sense of helplessness, and (3) negative sense of self. These results highlight that a major area underpinning experiences of diabetes distress is not feeling in control. Conclusions: Consideration should be given to how psychological factors, such as locus of control and learned helplessness, may constitute underlying mechanisms impacting emotional regulation in those experiencing diabetes distress. Clinicians should consider including and leading discussions around distress during appointments, as well as using approaches that promote patient autonomy and empowerment., Competing Interests: The authors have no conflicts of interest to declare., (Copyright © 2024 Louise Anne Morales-Brown et al.)

Competing Interests: The author has no conflicts of interest to disclose.

Cognitive frailty (CF) is the conjunction of cognitive impairment without dementia and physical frailty. While predictors of each element are well-researched, mechanisms of their co-occurrence have not been integrated, particularly in terms of relationships between social, psychological, and biological factors. This interdisciplinary scoping review set out to categorise a heterogenous multidisciplinary literature to identify potential pathways and mechanisms of CF, and research gaps. Studies were included if they used the definition of CF OR focused on conjunction of cognitive impairment and frailty (by any measure), AND excluded studies on specific disease populations, interventions, epidemiology or prediction of mortality. Searches used Web of Science, PubMed and Science Direct. Search terms included "cognitive frailty" OR (("cognitive decline" OR "cognitive impairment") AND (frail*)), with terms to elicit mechanisms, predictors, causes, pathways and risk factors. To ensure inclusion of animal and cell models, keywords such as "behavioural" or "cognitive decline" or "senescence", were added. 206 papers were included. Descriptive analysis provided high-level categorisation of determinants from social and environmental through psychological to biological. Patterns distinguishing CF from Alzheimer's disease were identified and social and psychological moderators and mediators of underlying biological and physiological changes and of trajectories of CF development were suggested as foci for further research., Competing Interests: Declaration of Competing Interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests. Carol Holland reports financial support was provided by UKRI BBSRC & MRC BB/W018322/1, which support was relevant for all authors. Carol Holland reports a relationship with Brocher Foundation that includes: travel reimbursement. Carol Holland reports a relationship with CONGRESO INTERNACIONAL DE PSICOLOGIA Y EDUCACIÓN, Spain that includes: speaking and lecture fees and. travel reimbursement. Alexandre Benedetto reports further financial support from the UKRI BBSRC BB/S017127/1. If there are other authors, they declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Authors. Published by Elsevier B.V. All rights reserved.)