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Given the fact that women in homelessness face considerable health inequities, the question of how digitalization can be understood in relation to social rights and right to health surfaces. The objective of this qualitative interview study was to explore the use of mobile phones and internet for women experiencing homelessness. Women (n = 26) shared experiences of healthcare access by using a mobile phone or internet. Data were analyzed using NVivo software. The results are presented in two themes: Conditions and circumstances of having a mobile phone; and Structural and intrapersonal challenges affecting social rights. The results show that digitalization actively influenced everyday life for women experiencing homelessness. Whether women wanted it to or not, digitalization presents a line of demarcation for participation and inclusion or exclusion, in health- and social-care services.

This paper presents a stochastic approach for the aggregation process rate in the ICOsahedral Nonhydrostatic general circulation model (ICON-AES), which takes subgrid-scale variability into account. This method creates a stochastic parameterization of the process rate by choosing a new specific cloud ice mass at random from a uniform distribution function. This distribution, which is consistent with the model's cloud cover scheme, is evaluated in terms of cloud ice mass variance with a combined satellite retrieval product (DARDAR) from the satellite cloud radar CloudSat and the Cloud–Aerosol Lidar and Infrared Pathfinder Observations (CALIPSO). The global patterns of simulated and observed cloud ice mixing ratio variance are in a good agreement, despite an underestimation in the tropical regions, especially at lower altitudes, and an overestimation in higher latitudes from the modeled variance. Due to this stochastic approach the yearly mean of cloud ice shows an overall decrease. As a result of the nonlinear nature of the aggregation process, the yearly mean of the process rates increases when taking subgrid-scale variability into account. An increased process rate leads to a stronger transformation of cloud ice into snow and therefore to a cloud ice loss. The yearly averaged global mean aggregation rate is more than 20 % higher at selected pressure levels due to the stochastic approach. A strong interaction of aggregation and accretion, however, lowers the effect of cloud ice loss due to a higher aggregation rate. The new stochastic method presented lowers the bias of the aggregation rate.

The Arctic Ocean halocline separates the cold surface mixed layer from the underlying warm Atlantic Water (AW), and thus provides a precondition for sea ice formation. Here, we introduce a new method in which the halocline base depth is determined from vertical stability and compare it to two existing methods. We also propose a novel method for detecting the cold halostad, a layer characterized by a small vertical salinity gradient, which is formed by the Pacific Winter Water in the Canada Basin or by meltwater off the eastern coast of Greenland and off Svalbard. Our main motivation for determining the halocline base depth depending on vertical stability was that vertical stability is closely related to vertical mixing and heat exchange. Vertical stability is a crucial parameter for determining whether the halocline can prevent vertical heat exchange and protect sea ice from warm AW. When applied to measurements from ice-tethered profilers, ships, and moorings, the new method for estimating the halocline base depth provides robust results with few artifacts. Analyzing a case in which water previously homogenized by winter convection was capped by fresh water at the surface suggests that the new method captured the beginning of new halocline formation in the Eurasian Basin. Comparatively large differences between the methods for detecting the halocline base depth were found in warm AW inflow regions for which climate models predict halocline thinning and increased net surface energy fluxes from the ocean to the atmosphere.

Abstract The Hamburg Aerosol Module version 2.3 (HAM2.3) from the ECHAM6.3‐HAM2.3 global atmosphere‐aerosol model is coupled to the recently developed icosahedral nonhydrostatic ICON‐A (icon‐aes‐1.3.00) global atmosphere model to yield the new ICON‐A‐HAM2.3 atmosphere‐aerosol model. The ICON‐A and ECHAM6.3 host models use different dynamical cores, parameterizations of vertical mixing due to sub‐grid scale turbulence, and parameter settings for radiation balance tuning. Here, we study the role of the different host models for simulated aerosol optical thickness (AOT) and evaluate impacts of using HAM2.3 and the ECHAM6‐HAM2.3 two‐moment cloud microphysics scheme on several meteorological variables. Sensitivity runs show that a positive AOT bias over the subtropical oceans is remedied in ICON‐A‐HAM2.3 because of a different default setting of a parameter in the moist convection parameterization of the host models. The global mean AOT is biased low compared to MODIS satellite instrument retrievals in ICON‐A‐HAM2.3 and ECHAM6.3‐HAM2.3, but the bias is larger in ICON‐A‐HAM2.3 because negative AOT biases over the Amazon, the African rain forest, and the northern Indian Ocean are no longer compensated by high biases over the sub‐tropical oceans. ICON‐A‐HAM2.3 shows a moderate improvement with respect to AOT observations at AERONET sites. A multivariable bias score combining biases of several meteorological variables into a single number is larger in ICON‐A‐HAM2.3 compared to standard ICON‐A and standard ECHAM6.3. In the tropics, this multivariable bias is of similar magnitude in ICON‐A‐HAM2.3 and in ECHAM6.3‐HAM2.3. In the extra‐tropics, a smaller multivariable bias is found for ICON‐A‐HAM2.3 than for ECHAM6.3‐HAM2.3.

The current gold standard to treat large cartilage defects is autologous chondrocyte transplantation (ACT). As a new surgical method of cartilage regeneration, minced cartilage implantation (MCI) is increasingly coming into focus. The aim of this study is to investigate the influence of chondrogenesis between isolated and cultured chondrocytes compared to cartilage chips in a standardized inflammation model with the proinflammatory cytokine TNFα. Articular chondrocytes from bovine cartilage were cultured according to the ACT method to passage 3 and transferred to spheroid culture. At the same time, cartilage was fragmented (3) to produce cartilage chips. TNFα (20 ng/mL) was supplemented to simulate an inflammatory process. TNFα had a stronger influence on the passaged chondrocytes compared to the non-passaged ones, affecting gene expression profiles differently between isolated chondrocytes and cartilage chips. MCI showed less susceptibility to TNFα, with reduced IL-6 release and less impact on inflammation markers. Biochemical and histological analyses supported these findings, showing a greater negative influence of TNFα on the passaged pellet cultures compared to the unpassaged cells and MCI constructs. This study demonstrated the negative influence of TNFα on chondrogenesis in a chondrocyte spheroid culture and cartilage fragment model. Passaged chondrocytes are more sensitive to cytokine influences compared to non-passaged cells and chondrons. This suggests that MCI may have superior regeneration potential in osteoarthritic conditions compared to ACT. Further investigations are necessary for the translation of these findings into clinical practice.

Objective: Femoral neck fractures in the elderly are a global health issue, with the choice between cemented and uncemented hemiarthroplasty remaining a topic of debate. This systematic review and meta-analysis aims to compare the effects of the two surgical options on health-related quality of life (HRQoL), mortality, and functional outcomes., Methods: We searched PubMed, Embase, and Cochrane databases for randomized controlled trials (RCTs) comparing cemented with uncemented hemiarthroplasty in patients aged 50 years and older with femoral neck fractures. The primary outcome of interest was HRQoL as measured by the European Quality of Life 5-Dimension Questionnaire (EQ-5D) score. Secondary outcomes included mortality, surgical, general, and local complications., Results: We included 20 RCTs with a total of 3680 patients with femoral neck fractures, of whom 1871 (50.5%) underwent cemented and 1809 (49.5%) uncemented hemiarthroplasty. The follow-up ranged from 1 to 6 years. The early (after 3-4 months) EQ-5D utility score (MD 0.07; 95% CI 0.03-0.12; p = 0.003; I 2  = 22%) and the 12-month EQ-5D utility score (MD 0.08; 95% CI 0.00-0.16; p = 0.04; I 2  = 67%) suggested an improved HRQoL in the cemented hemiarthroplasty group. The outcomes of 1-year mortality, requirement for additional surgeries, surgery duration, risk of pulmonary embolism, pressure sores or ulcers, intraoperative fractures, and periprosthetic or postoperative fractures demonstrated significant differences between the two groups., Conclusions: The use of cemented hemiarthroplasty in patients with femoral neck fractures presented better results when compared to uncemented hemiarthroplasty in terms of HRQoL during the first year after surgery and greater mortality reduction at 1 year follow-up and reduced the need for further surgery. Therefore, the use of cemented hemiarthroplasty may be preferred for the treatment of femoral neck fractures in elderly patients., (© 2024 The Author(s). Orthopaedic Surgery published by Tianjin Hospital and John Wiley & Sons Australia, Ltd.)

Background: We are lacking data with a high level of evidence on the use of episiotomy during instrumental delivery to prevent anal sphincter injury, which nonetheless presents the highest risk., Objective: Our main objective was to assess the protective effect of episiotomy against Obstetric Anal Sphincter Injury (OASI) in nulliparous women during instrumental delivery according to type of instrument. We also investigated its impact on immediate maternal and neonatal morbidity., Study Design: We conducted prospective comparative cohort study for clinical trial emulation by means of propensity score weighting. The study was especially designed for consideration of possible confounders. This was a nationwide observational multicenter study including 111 French public and private maternity units between April 2021 and March 2022. We included nulliparous women, with singleton cephalic fetus, at more than 34 weeks of gestation. We considered vacuum, forceps and spatula deliveries. We proceeded to a comparative analysis between women with and without episiotomy. The main outcome was obstetric anal sphincter injury occurrence. We used composite criteria for both maternal and neonatal immediate morbidity., Results: The analyses pertained to 11,013 women. Overall prevalence of episiotomy was 23%: 17% for vacuum (N=7007), 37% for forceps (N=2378), and 29% in case of spatulas-assisted (N=1628) delivery. Episiotomy was not associated with significantly decreased OASI occurrence in vacuum delivery (from 5.2% without episiotomy to 3.8%, OR=0.73 [0.48-1.03]) or forceps delivery (from 10.9% without episiotomy to 8.8%, OR=0.81 [0.56-1.14]). In contrast, we observed significantly decreased OASI occurrence (from 9.4% without episiotomy to 5.6%) in spatula delivery (OR=0.60 [0.37-0.87]). Episiotomy was associated with increased maternal morbidity using forceps (from 13.6% to 18.3%, OR=1.35 [1.01-1.73]) and spatulas (from 9.0% to 13.4%, OR=1.51 [1.11-2.00]). We also observed increased neonatal morbidity in vacuum delivery associated with episiotomy (from 9.1 to 13.6%, OR=1.49 [1.21-1.79]), but a decrease in case of forceps delivery with episiotomy (from 12.6% to 9.2%, OR=0.74 [0.55-0.95])., Conclusion: Episiotomy was not associated with a decreased risk of OASI in vacuum or forceps delivery, and a marginal reduction was achieved using spatulas. Our results do not favor extensive episiotomy during instrumental delivery., (Copyright © 2025 Elsevier Inc. All rights reserved.)

Background: Many patients experience a reduced quality of life for months after heart surgery. Besides medical factors, psychological factors such as preoperative expectations influence the recovery process. The ValvEx study investigated whether an expectation-focused preoperative intervention before heart valve surgery would i) increase positive realistic expectations, ii) reduce preoperative anxiety and iii) improve the postoperative recovery process., Methods: N = 89 patients undergoing heart valve surgery were randomized into one of two groups after a baseline assessment: Standard medical care (SOC) vs. SOC plus psychological expectation-focused intervention (EXPECT) on the day of hospital admission. Further assessments were conducted on the evening before surgery, four to six days and three months after surgery. The primary outcome was illness-related disability. Constrained longitudinal data analyses were conducted to analyze the intervention effects, while the need for information was considered as a potential moderator., Results: No general effects were observed for the EXPECT intervention over time regarding the primary outcome illness-related disability (Pain Disability Index, PDI) and the secondary outcomes (p ≥ .167). The intervention effects were moderated by the individual need for information: Patients with a higher need for information who received the EXPECT intervention were less anxious on the evening before surgery (p = .020, d = 0.314) and less restricted in their quality of life four to six days after surgery compared to patients who received SOC (p = .005, d = 0.464)., Conclusions: The ValvEx study is the first multicentre study investigating the expectation-optimizing preoperative intervention in heart valve patients. The implementation of the EXPECT intervention seemed to optimize outcomes after heart valve surgery for certain patients, such as patients with a high need for information. It is possible that there were no direct effects of the EXPECT intervention because the intervention dose was too low. These preliminary findings need to be corroborated by larger multi-center trials. Trial registration The study was preregistered at ClinicalTrials (identifier: NCT04502121, https://clinicaltrials.gov/study/NCT04502121)., Competing Interests: Disclosures This work was supported by the the German Heart Foundation (“Deutsche Stiftung für Herzforschung”) (F/41/20 PI Dr. Salzmann). The authors have no conflicts of interest to declare that are relevant to the content of this article., (Copyright © 2025. Published by Elsevier Inc.)

Objective: The expanding field of hematopoietic cell transplantation (HCT) for non-malignant diseases, including those amenable to gene therapy or gene editing, faces challenges due to limited donor availability and the toxicity associated with cell collection methods. Umbilical cord blood (CB) represents a readily accessible source of hematopoietic stem and progenitor cells (HSPCs); however, the cell dose obtainable from a single cord blood unit is frequently insufficient. This limitation can be addressed by enhancing the potency of HSPCs, specifically their capacity to reconstitute hematopoiesis. In our study, we investigated the combined effects of treprostinil, a prostaglandin analog, and cinacalcet, a calcium-sensing receptor modulator, on the reconstitution of hematopoiesis., Methods: A Lineage Cell Depletion Kit was employed to isolate lineage-negative (lin - ) HSPCs from mouse bone marrow. A Human CB CD34 Positive Selection Kit was utilized to isolate CD34 + cells from the CB of healthy donors. In vitro , the effects of treprostinil, cinacalcet, and their combination on the migration, adhesion, and differentiation of HSPCs were assessed. In vivo , homing and engraftment were examined. Eight-week-old female and male C57BL/6J, BALB/c, or female NSG mice served as recipient models., Results: When administered concomitantly, treprostinil and cinacalcet exhibited mutual antagonism: the survival of recipient animals was lower when both drugs were administered together compared to either agent alone. Conversely, a sequential regimen involving priming with treprostinil/forskolin followed by cinacalcet treatment in vivo enhanced survival, irrespective of whether hematopoiesis was reconstituted by human or murine HSPCs. In vitro assays demonstrated enhanced migration and adhesion in response to the presence of treprostinil and cinacalcet, suggesting potential synergistic effects. Colony formation confirmed synergism., Conclusion: Augmenting the bone marrow reconstitution potential of HSPCs with treprostinil and cinacalcet shows promise for rescuing patients undergoing HCT. This approach is particularly beneficial for those patients at high risk of transplant failure due to limited numbers of available HSPCs. Furthermore, enhancing the potency of HSPCs has the potential to alleviate the burden and risks associated with HSPC donation, as it would reduce the number of cells needed for collection., Competing Interests: Author WS was employed by AOP Orphan Pharmaceuticals GmbH. Author GK was employed by AOP Health International Management AG. GK is advising AOP Orphan Pharmaceuticals on R + D projects. The decision to submit the article for publication and the time point for publication was coordinated with the company to allow for patent submission. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2025 Prchal-Murphy, Zehenter, Fischer, Pirabe, Themanns, Afrashteh, Putz, Kollmann, Basílio, Salzmann, Strohmaier, Krumpl, Farr, Sexl, Freissmuth and Zebedin-Brandl.)

Amyotrophic lateral sclerosis (ALS) is a rare neurodegenerative disease characterized by motor neuron loss in the motor cortex, brain stem, and spinal cord. Mutations in the superoxide dismutase 1 (SOD1) gene, resulting in misfolding of its protein product, are a common cause of ALS. Currently, there is no approved ALS diagnostic tool. Here, we present the development of a PET radiotracer, [ 89 Zr]Zr-desferoxamine (DFO)-α-miSOD1, targeting selectively misfolded SOD1 (misSOD1). Methods: DFO-α-miSOD1 was prepared by conjugating α-miSOD1 antibody with DFO and labeled with 89 Zr. A longitudinal imaging study was performed to identify the optimal mouse age and time after administration of [ 89 Zr]Zr-DFO-α-miSOD1 for the detection of misSOD1 aggregation in transgenic mice overexpressing misSOD1 and in wild-type mice. Subsets of mice were either coinjected with an excess of α-miSOD1 or imaged with deglycosylated [ 89 Zr]Zr-DFO-α-miSOD1 to assess target specificity. The internal radiation dose for [ 89 Zr]Zr-DFO-α-miSOD1 was estimated by extrapolating data from mouse biodistribution experiments. Results: Imaging with [ 89 Zr]Zr-DFO-α-miSOD1 was optimal in 136-d-old transgenic mice on day 10 after administration. Significant accumulation of [ 89 Zr]Zr-DFO-α-miSOD1 was detected in the spinal cord and cartilage of ALS transgenic mice compared with the wild-type mice ( P = 0.01). The radiotracer accumulation is selective and blockable with an excess of α-miSOD1. Deglycosylated [ 89 Zr]Zr-DFO-α-miSOD1 results in high-contrast detection of misSOD1 but is prone to aggregation. The dosimetry for [ 89 Zr]Zr-DFO-α-miSOD1 is comparable to that for other 89 Zr-based tracers currently used in humans. Conclusion: This work thus establishes that [ 89 Zr]Zr-DFO-α-miSOD1 PET can detect misSOD1 in transgenic mice, paving the way for application in early diagnosis of ALS and therapeutic monitoring., (© 2025 by the Society of Nuclear Medicine and Molecular Imaging.)

Aim: Inpatient-Equivalent Home Treatment (IEHT) for mental health is new in Germany and therefore requires quality development. A best practice model (BPM) for IEHT is being developed from a service user perspective., Methods: 1. Collection and organization of evidence (literature review; n=55 interviews with service users), 2. qualitative analysis and formulation of criteria; 3. consensus and grouping of criteria (Delphi process)., Results: 58 Best practice criteria were developed in 8 groups: 1. Information, access and crisis management; 2. Treatment framework, end of treatment and continuity; 3. Scheduling, organization of contacts and flexibility; 4. Practical support and activation; 5. Treatment and therapy services; 6. Treatment team and staff; 7. Relatives, caregivers and community; and 8. Privacy and behavior in the home environment., Conclusion: The BPM provides initial guidance for a user-centered assessment of the implementation of IEHT., Competing Interests: Die Autorinnen/Autoren geben an, dass kein Interessenkonflikt besteht., (Thieme. All rights reserved.)

Background: Reliable scientific information is crucial for assessing hip function and evaluating the success of hip surgery. The Harris Hip Score (HHS) is the most widely used tool for measuring hip function and, in particular, the outcomes of hip surgery. The aim of this study was to conduct a systematic review of the literature to identify randomized controlled trials (RCTs) that reported the HHS for hip replacement treatment groups and to test whether there was a substantial difference between reporting only the postoperative HHS or the HHS difference (HHSdiff)., Methods: PubMed, CNKI, and Epistemonikos were searched until March 1, 2024. The risk of bias, level of evidence, and publication bias were assessed. As HHS is a continuous outcome, mean difference (MD) with 95% confidence intervals (CIs) was calculated using the Hartung-Knapp-Sidik-Jonkman method and a common-effect/random-effects model. The same approach was used for both postoperative HHS and HHSdiff. The effect of the two treatment groups studied (minimally invasive vs. conventional approach) on postoperative HHS was then compared with the effect of the two groups studied on the difference in HHS., Results: A total of 41 RCTs, involving 3572 patients, with a low to high risk of bias and a low to moderate publication bias were included. The measured outcome parameters showed a low to moderate level of evidence. There was no relevant difference in the reporting of HHS only postoperatively or HHSdiff when comparing two hip replacement treatment groups in RCTs, measured at 0-0.5, 3, 6, and 12 months postoperatively., Conclusion: The present study showed that there is no relevant difference between reporting of the HHS only postoperatively or HHSdiff when comparing two hip replacement treatment groups in RCTs. Both methods of HHS reporting produced comparable results in an identical cohort of 3765 patients undergoing hip replacement surgery., (© 2024 The Author(s). Orthopaedic Surgery published by Tianjin Hospital and John Wiley & Sons Australia, Ltd.)

Purpose: The aim of this study was to conduct a systematic review and meta-analysis on the reliability and applicability of artificial intelligence (AI)-based analysis of leg axis parameters. We hypothesized that AI-based leg axis measurements would be less time-consuming and as accurate as those performed by human raters., Methods: The study protocol was registered with the International Prospective Register of Systematic Reviews (PROSPERO). PubMed, Epistemonikos, and Web of Science were searched up to 24 February 2024, using a BOOLEAN search strategy. Titles and abstracts of identified records were screened through a stepwise process. Data extraction and quality assessment of the included papers were followed by a frequentist meta-analysis employing a common effect/random effects model with inverse variance and the Sidik-Jonkman heterogeneity estimator., Results: A total of 13 studies encompassing 3192 patients were included in this meta-analysis. All studies compared AI-based leg axis measurements on long-leg radiographs (LLR) with those performed by human raters. The parameters hip knee ankle angle (HKA), mechanical lateral distal femoral angle (mLDFA), mechanical medial proximal tibial angle (mMPTA), and joint-line convergence angle (JLCA) showed excellent agreement between AI and human raters. The AI system was approximately 3 min faster in reading standing long-leg anteroposterior radiographs (LLRs) compared with human raters., Conclusion: AI-based assessment of leg axis parameters is an efficient, accurate, and time-saving procedure. The quality of AI-based assessment of the investigated parameters does not appear to be affected by the presence of implants or pathological conditions., Level of Evidence: Level I., (© 2024 The Author(s). Knee Surgery, Sports Traumatology, Arthroscopy published by John Wiley & Sons Ltd on behalf of European Society of Sports Traumatology, Knee Surgery and Arthroscopy.)

Anterior cruciate ligament (ACL) injuries are common in sports and often require surgical intervention, e.g., ACL reconstruction (ACLR), aimed at restoring knee stability and enabling a return to pre-injury activity levels. The choice of graft is crucial, impacting biomechanical properties, clinical outcomes, and complication rates, and is especially important in revision surgeries after graft failure. Over the past 30 years, trends in graft selection have evolved towards more individualized approaches, considering factors such as patient activity level, prior injuries, and tissue availability. In Europe, autografts like hamstring tendon (HT), bone-patellar tendon-bone (BTB), and quadriceps tendon (QT) are preferred, with the increasing use of QT grafts. This review synthesizes the current literature on graft selection and its influence on ACLR outcomes.

Background/objectives: The extracellular calcium-sensing receptor (CaSR) is a multifunctional receptor proposed as a possible drug target for inflammatory bowel disease. We showed previously that CaSR inhibition with NPS 2143, a negative allosteric modulator of the CaSR, somewhat ameliorated the symptoms of chemically induced severe colitis in mice. However, it was unclear whether the potential of CaSR inhibition to reduce colitis may have been overshadowed by the severity of the induced inflammation in our previous study. Therefore, we tested if CaSR inhibition could prevent medium-grade colitis., Methods: Female BALB/c mice were treated with NPS 2143 or a vehicle prior to the induction of colitis with 2.5% DSS. On the day of sacrifice, colons and plasma were collected. The histology score was determined based on hematoxylin-eosin-stained sections. Mucin content, proliferation (Ki67), and immune cell infiltration (CD3 and CD20) were quantified based on immunostainings. Gene expression was measured by RT-qPCR., Results: Treatment with NPS 2143 had no effect on the clinical symptom score of the mice. However, the colons of the mice in the treated group were significantly longer ( p < 0.05), and NPS 2143 significantly reduced colon ulceration ( p < 0.05). The treatment also significantly reduced the expression of COX2 in the proximal colon and IL-22 in the distal colon. The proliferation of cells in the lymph nodes was significantly lower after the treatment, but no difference was observed in the epithelial cells., Conclusions: In summary, while NPS 2143 had an anti-inflammatory effect on medium-grade colitis, this effect appeared to be milder than in severe colitis, as observed previously, indicating that the effectiveness of CaSR inhibition as an anti-inflammatory measure in the colon is proportional to disease severity.

Aims: The transepicondylar axis is a well-established reference for the determination of femoral component rotation in total knee arthroplasty (TKA). However, when severe bone loss is present in the femoral condyles, rotational alignment can be more complicated. There is a lack of validated landmarks in the supracondylar region of the distal femur. Therefore, the aim of this study was to analyze the correlation between the surgical transepicondylar axis (sTEA) and the suggested dorsal cortex line (DCL) in the coronal plane and the inter- and intraobserver reliability of its CT scan measurement., Methods: A total of 75 randomly selected CT scans were measured by three experienced surgeons independently. The DCL was defined in the coronal plane as a tangent to the dorsal femoral cortex located 75 mm above the joint line in the frontal plane. The difference between sTEA and DCL was calculated. Descriptive statistics and angulation correlations were generated for the sTEA and DCL, as well as for the distribution of measurement error for intra- and inter-rater reliability., Results: The external rotation of the DCL to the sTEA was a mean of 9.47° (SD 3.06°), and a median of 9.2° (IQR 7.45° to 11.60°), with a minimum value of 1.7° and maximum of 16.3°. The measurements of the DCL demonstrated very good to excellent test-retest and inter-rater reliability coefficients (intraclass correlation coefficient 0.80 to 0.99)., Conclusion: This study reveals a correlation between the sTEA and the DCL. Overall, 10° of external rotation of the dorsal femoral cortical bone to the sTEA may serve as a reliable landmark for initial position of the femoral component. Surgeons should be aware that there are outliers in this study in up to 17% of the measurements, which potentially could result in deviations of femoral component rotation., Competing Interests: The author(s) received no financial or material support for the research, authorship, and/or publication of this article., (© 2024 Salzmann et al.)

Purpose: To shed light on and analyse the intersection between logical empiricism and qualitative nursing research, and to emphasize a post-structuralist critique to traditional methodological constraints., Methods: In this study, a critical examination is conducted through a post-structuralist lens, evaluating entrenched methodologies within nursing research. This approach facilitates a nuanced exploration of the intersection between logical empiricism and qualitative nursing research, challenging traditional methodological paradigms., Results: The article focusing on the "what abouts" of sample size, analytic framework, data source, data analysis, and rigour and methodological considerations, challenging the predominance of semi-structured interviews and the reliance on spoken voice as primary data sources, and re-evaluating the conventional notion of "rigour"., Conclusions: I advocate for a shift from qualitative positivism towards more interpretive and post-qualitative inquiries, this work proposes new trajectories through interpretive, critical, post-qualitative, and artistic turns in nursing research, aiming to transcend positivist limitations and foster a plurality of perspectives and research as praxis. Implications emphasize the need for nursing researchers to expand methodological horizons, incorporating visual and artistic methods to enrich understanding and representation of health experiences, moving beyond positivist norms towards a more inclusive and ethically sound research paradigm.

A recent trend in Non-Rigid Structure-from-Motion (NRSfM) is to express local, differential constraints between pairs of images, from which the surface normal at any point can be obtained by solving a system of polynomial equations. While this approach is more successful than its counterparts relying on global constraints, the resulting methods face two main problems: First, most of the equation systems they formulate are of high degree and must be solved using computationally expensive polynomial solvers. Some methods use polynomial reduction strategies to simplify the system, but this adds some phantom solutions. In any event, an additional mechanism is employed to pick the best solution, which adds to the computation without any guarantees on the reliability of the solution. Second, these methods formulate constraints between a pair of images. Even if there is enough motion between them, they may suffer from local degeneracies that make the resulting estimates unreliable without any warning mechanism. In this paper, we solve these problems for isometric/conformal NRSfM. We show that, under widely applicable assumptions, we can derive a new system of equations in terms of the surface normals, whose two solutions can be obtained in closed-form and can easily be disambiguated locally. Our formalism also allows us to assess how reliable the estimated local normals are and to discard them if they are not. Our experiments show that our reconstructions, obtained from two or more views, are significantly more accurate than those of state-of-the-art methods, while also being faster.

Background: This article is part of a larger study exploring the collaborative dynamics between key stakeholders in providing care to youths suffering from alcohol or substance use and their families in formulating policies and operational practices for county and country-wide application in similar settings. The focus of this article is to describe the collaborative processes between two stakeholders, a municipality, and a county council, in establishing a MiniMaria treatment center. While collaborative efforts between municipalities and county councils in health service provision are often acknowledged, little is known about how communication and decision-making processes between these entities shape the success of such initiatives. This study aims to fill this gap by providing insights into the communicative processes that foster organizational cohesion, agility, and innovation. The guiding research question is: What communicative processes occur between the county council and municipal stakeholders during the planning phase of the MiniMaria treatment center?, Methods: The municipality and county council were selected based on purposive sampling, owing to the proximity and accessibility of the field. An exploratory and descriptive design, incorporating a participatory research approach, was employed for this qualitative investigation., Results: Two central themes, each underpinned by specific subthemes sum up the essence of our findings. The first theme underscores the collaborative dynamics and shared objectives that have emerged through the project, thus showing the importance of a unified vision and mutual understanding in driving the initiative forward. The second theme points to the practical aspects of implementing the project, including recruitment strategies, and the significance of interpersonal communication., Conclusions: This article sheds light on the establishment of a MiniMaria treatment center through collaboration between a municipality and county council, using the Four Flows Model to interpret communicative processes. Membership negotiation was crucial for defining roles and building a unified team identity, while activity coordination ensured aligned stakeholder efforts. Self-structuring facilitated internal organization and operational clarity, and institutional positioning aligned the initiative with broader healthcare norms, enhancing its credibility and impact. These communicative practices were central to get a grip on inter-organizational complexities, emphasizing communication's constitutive role in organizational development and innovation., (© 2024. The Author(s).)

Objective: Autoethnography combines personal experiences with cultural analysis, emerging as a response to the limitations of traditional ethnography. This review aimed to explore, describe, and delineate the utilization of autoethnography by nurses published in peer-reviewed journals., Methods: A scoping review was conducted according to the Arksey and O'Malley framework. On October 12, 2023, autoethnographic studies in nursing were identified through searches of CINAHL, PubMed, PsycINFO, and Scopus. Peer-reviewed articles published in English language were retrieved. We applied no date restriction. Data were extracted on nursing, epiphany, results, style of writing, implications for nursing, and ethical considerations., Results: Twenty-six articles met the inclusion criteria. Mental health nursing, covered by nine articles, elucidated experiences of stigma, ethical dilemmas, and professional identity. Nursing education, represented by seven articles, highlighted identity struggles, systemic biases, and evolving pedagogies. Palliative care, addressed by three articles, provided insights into communication challenges and emotional complexities in end-of-life care. The remaining articles explored rehabilitation, cultural competence, and chronic pain management. A conceptual framework integrating ontological, epistemological, ethical, and practical dimensions was developed, emphasizing the interplay between personal and professional roles., Conclusions: This review underscores autoethnography's value in uncovering the cultural and ethical dimensions of nursing. This framework advocates for a reflective, culturally attuned approach to healthcare, fostering transformative changes in nursing. Further research should explore underrepresented nursing specialties to harness autoethnography's potential fully., Competing Interests: The authors declare no conflict of interest., (© 2024 The Authors.)

Purpose: Unicondylar arthroplasty was performed using robotic medial unicompartmental knee arthroplasty (R-mUKA) and gap-balancing instrumentation. Our hypothesis was that robotic unicondylar knee arthroplasty accurately restores component positioning and lower limb alignment when compared to preoperative planning with actual implantation throughout the range of knee motion due to proper knee balancing., Methods: Data were collected prospectively and were analysed for patients undergoing RM-UKA. A cemented UKA was implanted using the MAKO® robotic system. Lower limb alignment at 0°, 30°, 45°, 60° and 90° of flexion was recorded of the native knee, with the trial components in place and finally after component implantation. A spacer according to the femorotibial gap was introduced and the alignment was measured. The position of the final component was planned based on three-dimensional computed tomography images before making the bone cuts. The positioning of the femoral and tibial components was analysed in all three planes., Results: A total of 52 patients were included (mean age 66.3 ± 6.7 years; 34 males, 18 females). The difference in femoral component position after planning and final implantation was 0.04° ± 0.58° more valgus in the coronal plane (p = 0.326) and 0.6° ± 1.4° more flexion relative to the sagittal plane (p = 0.034). The tibial component was placed in the coronal plane in 0.3° ± 0.8° of more varus (p = 0.113) and in the sagittal plane in 0.6° ± 1.2° of more posterior tibial slope (p = 0.001). Lower limb alignment of the native knee in extension was 5.8° ± 2.6° of varus and changed to 3° ± 2.1° varus after UKA (p ≤ 0.01)., Conclusion: R-mUKA helps to achieve the target of alignment and component position without any significant differences to the planning. Ligament balancing causes non-significant changes in component position. It allows optimal component position even for off-the-shelf implants respecting the patient's specific anatomy., Level of Evidence: II., (© 2024 European Society of Sports Traumatology, Knee Surgery and Arthroscopy.)

Artificial Intelligence (AI) is a dynamic area of computer science that is constantly expanding its practical benefits in various fields. The aim of this study was to analyze AI-guided radiological assessment of femoral neck fractures by performing a systematic review and multilevel meta-analysis of primary studies. The study protocol was registered in the International Prospective Register of Systematic Reviews (PROSPERO) on May 21, 2024 [CRD42024541055]. The updated Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines were strictly followed. A systematic literature search of PubMed, Web of Science, Ovid (Med), and Epistemonikos databases was conducted until May 31, 2024. Critical appraisal using the Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2) tool showed that the overall quality of the included studies was moderate. In addition, publication bias was presented in funnel plots. A frequentist multilevel meta-analysis was performed using a random effects model with inverse variance and restricted maximum likelihood heterogeneity estimator with Hartung-Knapp adjustment. The accuracy between AI-based and human assessment of femoral neck fractures, sensitivity and specificity with 95% confidence intervals (CIs) were calculated. Study heterogeneity was assessed using the Higgins test I 2 (low heterogeneity <25%, moderate heterogeneity: 25%-75%, and high heterogeneity >75%). Finally, 11 studies with a total of 21,163 radiographs were included for meta-analysis. The results of the study quality assessment using the QUADAS-2 tool are presented in Table 2. The funnel plots indicated a moderate publication bias. The AI showed excellent accuracy in assessment of femoral neck fractures (Accuracy = 0.91, 95% CI 0.83 to 0.96; I 2  = 99%; p < 0.01). The AI showed good sensitivity in assessment of femoral neck fractures (Sensitivity = 0.87, 95% CI 0.77 to 0.93; I 2  = 98%; p < 0.01). The AI showed excellent specificity in assessment of femoral neck fractures (Specificity = 0.91, 95% CI 0.77 to 0.97; I 2  = 97%; p < 0.01). AI-guided radiological assessment of femoral neck fractures showed excellent accuracy and specificity as well as good sensitivity. The use of AI as a faster and more reliable assessment tool and as an aid in radiological routine seems justified., (© 2024 The Author(s). Orthopaedic Surgery published by Tianjin Hospital and John Wiley & Sons Australia, Ltd.)

Background: The aim of the study was to compare the short-term outcome of SuperPATH, direct anterior (DAA) and conventional approach (CA) hemiarthroplasty (HA) in patients with femoral neck fractures using a network meta-analysis., Methods: PubMed, China National Knowledge Infrastructure, Epistemonikos, and Embase were searched until May 31, 2024. In a network meta-analysis, mean differences with 95% confidence intervals were calculated using the Hartung-Knapp-Sidik-Jonkman method and a fixed/random effects model for continuous outcomes, and odds ratios with 95% confidence intervals were calculated using the Mantel-Haenszel method and a fixed/random effects model for dichotomous outcomes., Results: The literature search identified a total of 9 randomized controlled trials on SuperPATH with 762 patients and 8 randomized controlled trials on DAA with 641 patients. In the overall ranking, SuperPATH was placed first, DAA second and CA third. SuperPATH HA was best in 7, second best in 2 and third best in 1 of the 10 outcome parameters. DAA HA was best in 2 and second best in 8 of the 10 outcome parameters. CA HA was best in 1 and third best in 9 of the 10 outcome parameters. In the indirect comparison between SuperPATH HA and DAA HA, SuperPATH HA had a 1.36 point lower visual analog scale at 2 to 7 days postoperatively and a 0.17 lower overall complication rate compared to DAA., Conclusion: For the treatment of patients with femoral neck fractures, SuperPATH HA ranked first, DAA HA ranked second and CA HA ranked third. Based on the results, we recommend that trauma surgeons increase their use of minimally invasive hip HA techniques. It should be noted that SuperPATH HA had a significantly lower overall complication rate compared to DAA HA when the minimally invasive technique was chosen., Competing Interests: The authors have no conflicts of interest to disclose., (Copyright © 2024 the Author(s). Published by Wolters Kluwer Health, Inc.)

Background: Conflicts with patients and relatives occur frequently in intensive care units (ICUs), driven by factors that are intensified by critical illness and its treatments. A majority of ICU healthcare professionals have experienced verbal and/or physical violence. There is a need to understand how healthcare professionals in ICUs experience and manage this workplace violence., Methods: A qualitative descriptive analysis of four hospitals in Sweden was conducted using semi-structured focus-group interviews with ICU healthcare professionals., Results: A total of 34 participants (14 nurses, 6 physicians and 14 other staff) were interviewed across the four hospitals. The overarching theme: "The paradox of violence in healthcare" illustrated a normalisation of violence in ICU care and indicated a complex association between healthcare professionals regarding violence as an integral aspect of caregiving, while simultaneously identifying themselves as victims of this violence. The healthcare professionals described being poorly prepared and lacking appropriate tools to manage violent situations. The management of violence was therefore mostly based on self-taught skills., Conclusions: This study contributes to understanding the normalisation of violence in ICU care and gives a possible explanation for its origins. The paradox involves a multifaceted approach that acknowledges and confronts the structural and cultural dimensions of violence in healthcare. Such an approach will lay the foundations for a more sustainable healthcare system., (© 2024. The Author(s).)

Background: It remains unclear whether the use of an orthopaedic traction table (TT) in direct anterior approach (DAA) total hip arthroplasty (THA) results in better outcomes. The aim of this systematic review and network meta-analysis was to compare the THA outcomes through DAA on a standard operating table and the THA outcomes through DAA on a TT., Methods: PubMed, Epistemonikos, and Google Scholar were searched for relevant randomized controlled trials (RCTs) up to 01 January 2024. An indirect comparison in network meta-analysis was performed to assess treatment effects between DAA on a TT and DAA on a standard table, using fixed-effects and random-effects models estimated with frequentist approach and consistency assumption. Standardized mean differences (SMDs) with 95% confidence intervals (CIs) were estimated for continuous variables and odds ratios (ORs) with 95% CIs were estimated for binary variables., Results: The systematic review of the literature identified 43 RCTs with a total of 2,258 patients. DAA with TT had a 102.3 mL higher intraoperative blood loss and a 0.6 mmol/L lower Hb 3 days postoperatively compared with DAA without TT (SMD = 102.33, 95% CI 47.62 to 157.04; SMD = - 0.60, 95% CI  - 1.19 to - 0.00). DAA with TT had a 0.15 lower periprosthetic fracture OR compared with DAA without TT (OR 0.15, 95% CI 0.03 to 0.86). There were no further significant differences in surgical, radiological, functional outcomes and in complication rates., Conclusion: Based on our findings and taking into account the limitations, we recommend that particular attention be paid to the risk of periprosthetic fracture in DAA on a standard operating table and blood loss in DAA with TT. Since numerous other surgical, radiological, functional outcome parameters and other complication rates studied showed no significant difference between DAA on a standard operating table and DAA with TT, no recommendation for a change in surgical technique seems justified., Level of Evidence: Level I evidence, because this is a systematic review and meta-analysis of randomized controlled trials., (© 2024. The Author(s).)

In this work, we tackle the task of estimating the 6D pose of an object from point cloud data. While recent learning-based approaches have shown remarkable success on synthetic datasets, we have observed them to fail in the presence of real-world data. We investigate the root causes of these failures and identify two main challenges: The sensitivity of the widely-used SVD-based loss function to the range of rotation between the two point clouds, and the difference in feature distributions between the source and target point clouds. We address the first challenge by introducing a directly supervised loss function that does not utilize the SVD operation. To tackle the second, we introduce a new normalization strategy, Match Normalization. Our two contributions are general and can be applied to many existing learning-based 3D object registration frameworks, which we illustrate by implementing them in two of them, DCP and IDAM. Our experiments on the real-scene TUD-L Hodan et al. 2018, LINEMOD Hinterstoisser et al. 2012 and Occluded-LINEMOD Brachmann et al. 2014 datasets evidence the benefits of our strategies. They allow for the first-time learning-based 3D object registration methods to achieve meaningful results on real-world data. We therefore expect them to be key to the future developments of point cloud registration methods.

Purpose: The aim of this study was to evaluate patellar mobility in patients before and after knee arthroplasty (KA) and compare it with that of healthy subjects. It was hypothesised that patellar mobility is diminished in patients with osteoarthritis (OA) and remains unchanged after KA., Methods: A total of 101 patients (59 females and 42 males) with a mean age of 70.9 ± 9.9 years underwent KA and were compared with 25 healthy individuals (seven females and 18 males) with a mean age of 32.3 ± 9.3 years. Mediolateral patellar displacement was measured by applying a force of 10 N, and the medial and lateral patellar shifts were recorded separately using a validated novel patellostabilometer. Patients were examined preoperatively and at 3 months postoperatively, assessing the range of knee motion and the clinical and functional status based on the Oxford Knee Score (OKS), Kujala Score, subjective Knee Society Score (sKSS), Forgotten Joint Score (FJS) and Western Ontario and McMaster Universities Arthritis Index (WOMAC)., Results: Total patellar displacement was 42.1 ± 6 mm for healthy subjects, 31 ± 6 mm before surgery and 32.8 ± 7.8 mm after surgery in osteoarthritic patients (p < 0.01). The mean lateral patellar shift differed significantly between healthy individuals (17.9 ± 4 mm) and osteoarthritic patients (15.1 ± 6 mm) (p < 0.01). The mean medial patellar mobility of healthy individuals (24.2 ± 7 mm) was significantly greater than that of osteoarthritic patients (15.8 ± 4.8 mm) (p < 0.01). All scores improved significantly postoperatively. No correlation was found between patellar mobility and OKS, Kujala Score, sKSS, FJS and WOMAC (r = -0.11). Improvement in patellar mobility also showed no correlation with clinical outcomes according to OKS, Kujala Score, sKSS, FJS and WOMAC (r = 0.08)., Conclusion: This study has demonstrated reduced patellar mobility in patients with OA. While patellar mobility significantly improved after KA, it may not hold clinical significance (p = 0.04). No impact on clinical outcome can be expected when the presurgical patella mobility is preserved in KA., Level of Evidence: Level IV., (© 2024 The Authors. Knee Surgery, Sports Traumatology, Arthroscopy published by John Wiley & Sons Ltd on behalf of European Society of Sports Traumatology, Knee Surgery and Arthroscopy.)

Background: The aim of the present study was to investigate the influence of various factors, in particular operation time, on mortality and complication rates in patients with femoral neck fractures who have undergone hip hemiarthroplasty (HHA) and to determine a cut-off value above which mortality and complication rates increase significantly., Methods: Cases of patients with femoral neck fracture treated with HHA between 1 January 2017 and 31 December 2023 were screened for eligibility. Multiple logistic regressions were calculated to determine which factors (patient age, experience of surgeon, patient sex, ASA score, time to surgery, operation time) influenced the incidence of complications and mortality. The exact cut-off value for complications and mortality was determined using the Youden index of the ROC curve (sensitivity vs. specificity) of logistic regression., Results: A total of 552 patients were considered eligible for this study. During the 90-day follow-up period after HHA, 50 deaths and 34 complications were recorded, giving a mortality rate of 9.1%, and a complication rate of 6.2%. Of the 34 complications recorded, 32.3% were infections, 14.7% dislocations, 20.7% trochanteric avulsions, 11.8% periprosthetic fractures, 11.8% nerve injuries, and 8.8% deep vein thrombosis. The odds ratio (OR) of a patient experiencing a complication is 2.2% higher for every minute increase in operation time (Exponential Beta - 1 = 0.022; p = 0.0363). The OR of a patient dying is 8.8% higher for each year increase in age (Exponential Beta - 1 = 0.088; p = 0.0007). When surgery was performed by a certified orthopaedic surgeon the mortality rate lowered by 61.5% in comparison to the surgery performed by a trainee (1 - Exponential Beta = 0.594; p = 0.0120). Male patients have a 168.7% higher OR for mortality than female patients (Exponential Beta - 1 = 1.687; p = 0.0017). Patients with an operation time of ≥ 86 min. have a 111.8% higher OR for mortality than patients with an operation time of < 86 min. (Exponential Beta - 1 = 1.118)., Conclusion: This retrospective data analysis found that the risk of a patient experiencing a complication was 2.2% higher for every minute increase in operation time. Patients with an operation time above the cut-off of 86 min had a 111.8% higher risk of mortality than those with an operation time below the cut-off. Other influencing factors that operators should be aware of include patient age, male sex, and operator experience., (© 2024. The Author(s).)

Communication in healthcare extends beyond patient care, impacting the work environment and job satisfaction. Interprofessional communication is essential for fostering collaboration, but challenges arise from differences in training, roles, and hierarchies. The study aimed to explore psychiatric outpatient clinicians' experiences of interprofessional communication and their perceptions of how the communication intersects the organizational and social work environment of healthcare. Qualitative research involved focus group interviews with clinicians from five psychiatric outpatient units in Central Sweden, representing diverse professions. The authors analyzed semi-structured interview data thematically to uncover clinicians' perspectives on interprofessional communication. An overarching theme, "Adjustment of communication," with subthemes "Synchronized communication" and "Dislocated communication," emerged. Clinicians adapted communication strategies based on situations and needs, with synchronized communication promoting collaboration and dislocated communication hindering it. Communicating with each other was highly valued, as it contributed to a positive work environment. The study underscores the importance of an open, supportive environment that fosters trust, and respect among healthcare clinicians. Consistent with prior research, collaboration gaps underscore the urgent need to improve interprofessional communication.

Background: Venous thromboembolism is a major health problem. After thrombus formation, its resolution is essential to re-establish blood flow, which is crucially mediated by infiltrating neutrophils and monocytes in concert with activated platelets and endothelial cells. Thus, we aimed to modulate leukocyte function during thrombus resolution post-thrombus formation by blocking P-selectin/CD62P-mediated cell interactions., Methods: Thrombosis was induced by inferior vena cava stenosis through ligation in mice. After 1 day, a P-selectin-blocking antibody or isotype control was administered and thrombus composition and resolution were analyzed., Results: Localizing neutrophils and macrophages in thrombotic lesions of wild-type mice revealed that these cells enter the thrombus and vessel wall from the caudal end. Neutrophils were predominantly present 1 day and monocytes/macrophages 3 days after vessel ligation. Blocking P-selectin reduced circulating platelet-neutrophil and platelet-Ly6C high monocyte aggregates near the thrombus, and diminished neutrophils and Ly6C high macrophages in the cranial thrombus part compared with isotype-treated controls. Depletion of neutrophils 1 day after thrombus initiation did not phenocopy P-selectin inhibition but led to larger thrombi compared with untreated controls. In vitro, P-selectin enhanced human leukocyte function as P-selectin-coated beads increased reactive oxygen species production by neutrophils and tissue factor expression of classical monocytes. Accordingly, P-selectin inhibition reduced oxidative burst in the thrombus and tissue factor expression in the adjacent vessel wall. Moreover, blocking P-selectin reduced thrombus density determined by scanning electron microscopy and increased urokinase-type plasminogen activator levels in the thrombus, which accelerated caudal fibrin degradation from day 3 to day 14. This accelerated thrombus resolution as thrombus volume declined more rapidly after blocking P-selectin., Conclusions: Inhibition of P-selectin-dependent activation of monocytes and neutrophils accelerates venous thrombosis resolution due to reduced infiltration and activation of innate immune cells at the site of thrombus formation, which prevents early thrombus stabilization and facilitates fibrinolysis., Competing Interests: Disclosures None.

Vehicles can encounter a myriad of obstacles on the road, and it is impossible to record them all beforehand to train a detector. Instead, we select image patches and inpaint them with the surrounding road texture, which tends to remove obstacles from those patches. We then use a network trained to recognize discrepancies between the original patch and the inpainted one, which signals an erased obstacle.

Specialist literature lacks evidence that explores associations between patient characteristics and the beneficial treatment effect of SuperPATH hemiarthroplasty (HA) compared with conventional approach (CA) HA. To investigate and identify patient-related predictors of the effect size of the short-term functional outcome of SuperPATH HA and CA HA by performing a systematic review and meta-regression analysis of randomized controlled trials (RCTs). A systematic search of literature was performed in PubMed, CNKI, CENTRAL of The Cochrane Library, Clinical trials, and Google Scholar until August 25, 2023. For the continuous outcome parameter Harris hip score (HHS) ≤1 week and 3 months postoperatively, mean differences (MDs) with 95% confidence intervals (CIs) were calculated. A meta-regression analysis was based on random-effects meta-analysis using the Hartung-Knapp-Sidik-Jonkman method for continuous covariates. A total of five RCTs with 404 patients were found. The following predictors of HHS ≤1 week postoperatively were identified: patient age (predictor estimate = 1.29; p < 0.01), patient age groups (predictor estimate = 14.07; p < 0.01), time to mobilization (predictor estimate = 5.51; p < 0.01). The following predictors of HHS 3 months postoperatively were identified: incision length (predictor estimate = -2.12; p < 0.01); intraoperative blood loss (predictor estimate = 0.02; p < 0.01). Patient age, time to mobilization, incision length, and intraoperative blood loss were identified as predictors of the effect size of early postoperative functional outcome as measured by HHS. Elderly patients, particularly those over 70 years of age, appear to benefit from SuperPATH HA. Based on these findings, and taking into account our limitations, we recommend that the use of minimally invasive SuperPATH HA in elderly patients should be more widely considered and not limited to elective THA patients., (© 2024 The Authors. Orthopaedic Surgery published by Tianjin Hospital and John Wiley & Sons Australia, Ltd.)

Purpose: It was hypothesized that robotic arm-assisted total knee arthroplasty (RA-TKA) using additionally a gap-balancing instrumentation will show high accuracy in executing the planning in femoral and tibial component placement throughout the range of knee motion (ROM) during TKA surgery., Methods: Prospectively collected data were analysed for patients undergoing RA-TKA. A cruciate retaining cemented design was implanted using the MAKO® robotic system. Lower limb alignment at 0°, 30°, 45°, 60° and 90° of flexion was recorded at the beginning of surgery and finally after implantation of the components. A ligament tensioner was inserted after tibial precut to measure the extension and flexion gap, and final component placement was planned based on 3D CT images. Femoral and tibial component placement was measured in all three planes., Results: A total of 104 patients were included (mean age 69.4 ± 9 years; 44 male, 60 female). The difference in component placement after planning and final implantation showed less valgus of 0.7° ± 1.4° (p < 0.001), less external rotation of 0.6° ± 1.9° (p = 0.001) and less flexion of 0.9° ± 1.8° (p < 0.001) for the femoral component. The tibial component was placed in more varus of 0.2° ± 0.9° (p = 0.056) and more posterior slope of 0.5° ± 0.9° (p < 0.001). The lower limb alignment in extension was 4.4° ± 5.2° of varus of the native knee and changed to 1.2° ± 1.9° of varus after TKA (p < 0.01)., Conclusion: Robotic-assisted TKA helps to achieve the target of alignment and component placement very close to the planning. It allows optimal component placement of off-the-shelf implants respecting patient's specific anatomy., Level of Evidence: Level II., (© 2024 The Authors. Knee Surgery, Sports Traumatology, Arthroscopy published by John Wiley & Sons Ltd on behalf of European Society of Sports Traumatology, Knee Surgery and Arthroscopy.)

Background: During infection, neutrophil extracellular traps (NETs) are associated with severity of pulmonary diseases such as acute respiratory disease syndrome. NETs induce subsequent immune responses, are directly cytotoxic to pulmonary cells, and are highly procoagulant. Anticoagulation treatment was shown to reduce in-hospital mortality, indicating thromboinflammatory complications. However, data are sparsely available on the involvement of NETs in secondary events after virus clearance, which can lead to persistent lung damage and postacute sequelae with chronic fatigue and dyspnea., Objectives: This study focuses on late-phase events using a murine model of viral lung infection with postacute sequelae after virus resolution., Methods: C57BL/6JRj mice were infected intranasally with the betacoronavirus murine coronavirus (MCoV, strain MHV-A95), and tissue samples were collected after 2, 4, and 10 days. For NET modulation, mice were pretreated with OM-85 or GSK484 and DNase I were administered intraperitoneally between days 2 to 5 and days 4 to 7, respectively., Results: Rapid, platelet-attributed thrombus formation was followed by a second, late phase of thromboinflammation. This phase was characterized by negligible virus titers but pronounced tissue damage, apoptosis, oxidative DNA damage, and presence of NETs. Inhibition of NETs during the acute phase did not impact virus burden but decreased lung cell apoptosis by 67% and oxidative stress by 94%. Prevention of neutrophil activation by immune training before virus infection reduced damage by 75%, NETs by 31%, and pulmonary thrombi by 93%., Conclusion: NETs are detrimental inducers of tissue damage during respiratory virus infection but do not contribute to virus clearance., Competing Interests: Declaration of competing interests M.S., P.G., P.H., M.B., R.P., T.F., R.N., B.H., J.W., C.H., B.K.P., J.B.K-P. declare no conflict of interest. P.J.H. is a consultant for OM Pharma., (Copyright © 2023 International Society on Thrombosis and Haemostasis. Published by Elsevier Inc. All rights reserved.)

Background: Posthepatectomy liver failure (PHLF) represents a life-threatening complication with limited therapeutic options. Neutrophils play a critical and dynamic role during regeneratory processes, but their role in human liver regeneration is incompletely understood, especially as underlying liver disease, detectable in the majority of patients, critically affects hepatic regeneration. Here we explored intrahepatic neutrophil accumulation and neutrophil extracellular traps (NETs) in patients with PHLF and validated the functional relevance of NETs in a murine partial hepatectomy (PHx) model., Methods: We investigated the influx of neutrophils, macrophages, eosinophils, and mast cells and the presence of their respective extracellular traps in liver biopsies of 35 patients undergoing hepatectomy (10 patients with PHLF) before and after the initiation of liver regeneration by fluorescence microscopy. In addition, NET formation and neutrophil activation were confirmed by plasma analysis of 99 patients (24 patients with PHLF) before and up to 5 days after surgery. Furthermore, we inhibited NETs via DNase I in a murine PHx model of mice with metabolically induced liver disease., Results: We detected rapid intrahepatic neutrophil accumulation, elevated levels of myeloperoxidase release, and NET formation in regenerating human livers, with a significantly higher increase of infiltrating neutrophils and NETs in patients with PHLF. Circulating markers of neutrophil activation, including elastase, myeloperoxidase, and citrullinated histone H3, correlated with markers of liver injury. In a murine PHx model, we showed that the inhibition of NET accelerated hepatocyte proliferation and liver regeneration., Conclusions: Patients with PHLF showed accelerated intrahepatic neutrophil infiltration and NET formation, which were associated with liver damage. Further, we identified postsurgical myeloperoxidase levels as predictive markers for adverse outcomes and observed that blocking NETs in a murine PHx model accelerated tissue regeneration., (Copyright © 2023 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the American Association for the Study of Liver Diseases.)

Background: The elements of previously designed questionnaires do not take into consideration the burdens encountered in an inpatient hospital setting. The purpose of this study is to validate elements of a non-compliance survey in an in-hospital setting and discuss aspects of compliance with telerehabilitative physiotherapy in the early postoperative period., Methods: A literature search was conducted to identify elements that prevent patients from performing their prescribed physical therapy exercises. These items were then evaluated by the expert review technique as described by Ikart. Afterwards, the synthesized survey was handed out to patients for the assessment of the quality of its items., Results: The results of the expert review technique identified some conceptual and grammatical problems. This led to the adjustment of some of the elements. The quality of the resulting questionnaire was deemed to be good, as patients were able to fully understand the concepts and answer accordingly. A statistical analysis was conducted to evaluate the responses., Conclusions: The items of this second questionnaire have proven to be reliable to assess the compliance of patients in an in-hospital setting. These items will be added to the cross-culturally adapted items of a previous questionnaire.

Objective: This study is the first to explore user behavior and characterize the content shared about digital inclusion on Twitter., Methods: This mixed-methods research consists of 14,000 tweets featuring the hashtag "#digitalinclusion," posted on Twitter over 15 months. A machine learning technique, latent Dirichlet allocation, was utilized to discover abstract topics within the tweets statistically. The algorithm identified important keywords and text associated with each topic by modeling the underlying word co-occurrence patterns in the dataset. A manual qualitative content analysis was applied to the qualitative data (1000 tweets)., Results: Tweets containing #digitalinclusion are driven by four motives: 1) warning against the risks of digital exclusion; 2) tweets that promote actions to increase digital inclusion; 3) tweets that call for others to take action to improve digitalization; and 4) tweets that are neutral but fuel the debate by being active. Quantitative analysis revealed that users discussing digital inclusion come from various continents, including the USA, Europe, Africa, and Asia. There were 3931 unique user accounts, with individuals posting between one and 368 tweets. Approximately half of the tweets contained some embedded media., Conclusion: The study concludes that digital inclusion is a subject that engages Twitter users worldwide. Tweets that were associated with community and local initiatives and sustainable development had the highest engagement in terms of the number of retweets and likes. The interpretation is that digital inclusion is crucial for achieving equity in living conditions and enhancing access to health information and services. While initiatives to increase digital inclusion are underway, Twitter users call for more efforts to prevent growing digital exclusion. Twitter, as a social media platform, is valuable for studying the motivations that drive digital inclusion and help counter digital exclusion., Competing Interests: The author declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (© The Author(s) 2023.)

Psychiatric intensive care units (PICUs) provide care and treatment when psychiatric symptoms and behaviors exceed general inpatient resources. This integrative review aimed to synthesize PICU research published over the past 5 years. A comprehensive search in MEDLINE, PsycINFO, PubMed and Scopus identified 47 recent articles on PICU care delivery, populations, environments, and models. Research continues describing patient demographics, and high rates of challenging behaviors, self-harm, and aggression continue being reported. Research on relatives was minimal. Patients describe restrictive practices incongruent with recovery philosophies, including controlling approaches and sensory deprivation. Some initiatives promote greater patient autonomy and responsibility in shaping recovery, yet full emancipatory integration remains limited within PICU environments. Multidisciplinary collaboration is needed to holistically advance patient-centered, equitable, and integrative PICU care. This review reveals the complex tensions between clinical risk management and emancipatory values in contemporary PICU settings. Ongoing reporting of controlling practices counters the recovery movement progressing in wider mental healthcare contexts. However, care innovations centered on patient empowerment and humane environments provide hope for continued evolution toward more liberation-focused PICU approaches that uphold both patient and provider perspectives.

Background: Communication in healthcare has been extensively studied, but most research has focused on miscommunication and the importance of communication for patient safety. Previous research on interprofessional communication has mainly focused on relationships between physicians and nurses in non-psychiatric settings. Since communication is one of the core competencies in psychiatric care, more research on interprofessional communication between other clinicians is needed, and should be explored from a broader perspective. This study aimed to explore and describe interprofessional communication in a psychiatric outpatient unit., Method: During spring 2022, data consisting of over 100 h of fieldwork were collected from observations, formal semi-structured interviews and informal conversations inspired by the focused ethnography method. Data was collected at an outpatient unit in central Sweden, and various clinicians participated in the study. The data analysis was a back-and-forth process between initial codes and emerging themes, but also cyclical as the data analysis process was ongoing and repeated and took place simultaneously with the data collection., Results: We found that a workplace's history, clinicians´ workload, responsibilities and hierarchies influence interprofessional communication. The results showed that the prerequisites for interprofessional communication were created through the unit's code of conduct, clear and engaging leadership, and trust in the ability of the various clinicians to perform new tasks., Conclusion: Our results indicate that leadership, an involving working style, and an environment where speaking up is encouraged and valued can foster interprofessional communication and respect for each other´s professional roles is key to achieving this. Interprofessional communication between different clinicians is an important part of psychiatric outpatient work, where efficiency, insufficient staffing and long patient queues are commonplace. Research can help shed light on these parts by highlighting aspects influencing communication., (© 2023. BioMed Central Ltd., part of Springer Nature.)

Aims: Ischaemia-reperfusion injury (IRI) following myocardial infarction remains a challenging topic in acute cardiac care and consecutively arising heart failure represents a severe long-term consequence. The extent of neutrophil infiltration and neutrophil-mediated cellular damage are thought to be aggravating factors enhancing primary tissue injury. Toll-like receptor 9 was found to be involved in neutrophil activation as well as chemotaxis and may represent a target in modulating IRI, aspects we aimed to illuminate by pharmacological inhibition of the receptor., Methods and Results: Forty-nine male adult Sprague-Dawley rats were used. IRI was induced by occlusion of the left coronary artery and subsequent snare removal after 30 min. Oligonucleotide (ODN) 2088, a toll-like receptor 9 (TLR9) antagonist, control-ODN, or DNase, were administered at the time of reperfusion and over 24 h via a mini-osmotic pump. The hearts were harvested 24 h or 4 weeks after left coronary artery occlusion and immunohistochemical staining was performed. Echocardiography was done after 1 and 4 weeks to determine ventricular function. Inhibition of TLR9 by ODN 2088 led to left ventricular wall thinning (P = 0.003) in association with drastically enhanced neutrophil infiltration (P = 0.005) and increased markers of tissue damage. Additionally, an up-regulation of the chemotactic receptor CXCR2 (P = 0.046) was found after TLR9 inhibition. No such effects were observed in control-ODN or DNase-treated animals. We did not observe changes in monocyte content or subset distribution, hinting towards neutrophils as the primary mediators of the exerted tissue injury., Conclusions: Our data indicate a TLR9-dependent, negative regulation of neutrophil infiltration. Blockage of TLR9 appears to prevent the down-regulation of CXCR2, followed by an uncontrolled migration of neutrophils towards the area of infarction and the exertion of disproportional tissue injury resulting in potential aneurysm formation. In comparison with previous studies conducted in TLR -/- mice, we deliberately chose a transient pharmacological inhibition of TLR9 to highlight effects occurring in the first 24 h following IRI., (© 2023 The Authors. ESC Heart Failure published by John Wiley & Sons Ltd on behalf of European Society of Cardiology.)