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Current research underscores that there are only a few evidence-based programs that teach STEM (science, technology, engineering, and mathematics) as part of their curriculum, especially for autistic students. Even fewer programs focus on engineering and design learning. Hence, we developed an informal afterschool maker program to develop autistic and non-autistic students' interests in engineering to understand their experiences learning STEM concepts and values while applying the engineering mindset to develop projects. This qualitative study aimed to explore and understand students' experiences participating in STEM activities in the maker club. We interviewed twenty-six students (seventeen autistic and nine non-autistic), nine teachers, and thirteen parents representing diverse cultural and socio-economic backgrounds across three public middle schools in a large urban metropolitan city between 2018 and 2019. Our thematic analysis yielded four themes: (1) "active participation in STEM"; (2) "curiosity about STEM topics, concepts, and practices"; (3) "capacity-building to engage in STEM learning"; and (4) "understanding of the importance of STEM education in daily life." The results of this study enabled us to understand that students were deeply engaged with the content and curriculum of our program, expanded their knowledge base about scientific concepts, used engineering-specific scientific terminologies, and engaged with the engineering design process to conceptualize, test, improvise, and problem-solve. Furthermore, this afterschool engineering education program created a safe, nurturing, and stimulating environment for students to build engineering readiness skills.

This study compares student evaluations across face-to-face and online modalities, as well as qualitative versus quantitative courses, in a large sample of graduate-level courses from 2008 to 2023 at a US business school. The findings reveal significantly lower course and instructor evaluation ratings despite similar class performance in online modality. Quantitative courses received notably lower satisfaction ratings than qualitative courses. Importantly, when accounting for modality and course type, grades do not influence student evaluations. Maintaining fair comparisons by restricting evaluations solely to the same modality and course type is crucial for assessing college professors' teaching quality through student evaluation ratings.

Many youth on the autism spectrum possess interests and strengths for STEM-related postsecondary pathways, yet there are few research-based programs to support those interests and competencies including complex problem solving and social communication. This qualitative study explored the experiences and perceived outcomes of students, teachers, and parents participating in an inclusive, strength-based, extracurricular engineering design program entitled the IDEAS Maker Club. Twenty-six students, 13 parents, and nine teachers in the program completed interviews and program logs while researchers conducted classroom observations over 2 years. Thematic analysis identified five common themes: (1) positive student experience and engagement, (2) skills acquisition, (3) development of interest in STEM and related careers, (4) social relationships and community, and (5) safe spaces that supported self-determination.

Augmented baseplates can be effective at addressing eccentric glenoid wear in reverse total shoulder arthroplasty. However, these implants often come in a limited number of predetermined shapes that require additional reaming to ensure adequate glenoid seating. This typically involves complex instrumentation and can have a negative impact on implant stability. Modular baseplate augmentation based on intraoperative measurements may allow for more precise defect filling while preserving glenoid bone. The purpose of this investigation was to assess the stability of a novel ringed baseplate with modular augmentation in comparison with nonaugmented standard and ringed baseplate designs. In this biomechanical study, baseplate micromotion was tested for 3 constructs according to the American Society for Testing and Materials guidelines. The constructs included a nonaugmented curved baseplate, a nonaugmented ringed baseplate, and a ringed baseplate with an 8-mm locking modular augmentation peg. The nonaugmented constructs were mounted flush onto polyurethane foam blocks, whereas the augmented baseplate was mounted on a polyurethane block with a simulated defect. Baseplate displacement was measured before and after 100,000 cycles of cyclic loading. Before cyclic loading, the nonaugmented and augmented ringed baseplates both demonstrated significantly less micromotion than the nonaugmented curved baseplate design (81.1 μm vs. 97.2 μm vs. 152.7 μm; P =.009). After cyclic loading, both ringed constructs continued to have significantly less micromotion than the curved design (105.5 μm vs. 103.2 μm vs. 136.6 μm; P <.001). The micromotion for both ringed constructs remained below the minimum threshold required for bony ingrowth (150 μm) at all time points. In the setting of a simulated glenoid defect, locked modular augmentation of a ringed baseplate does not result in increased baseplate micromotion when compared with full contact nonaugmented baseplates. This design offers a simple method for tailored baseplate augmentation that can match specific variations in glenoid anatomy, limiting the need for excessive reaming and ultimately optimizing the environment for long-term implant stability. [ABSTRACT FROM AUTHOR]

Polypharmacy is commonly encountered by providers caring for patients with medically complex and palliative care needs in many settings. The purpose of this quality improvement project was to measure the impact of an evidence-based educational deprescribing intervention on polypharmacy rate and provider confidence and knowledge in the nursing home. We invited providers working in 52 nursing homes to attend a 1-hour-long educational deprescribing session. Twenty-one nurse practitioners and 1 physician assistant across 11 states participated in the intervention. Provider confidence level related to deprescribing improved in all categories, with statistical significance demonstrated with both paired t test and Wilcoxon signed rank test (P <.001). The polypharmacy rate 3 months after the intervention decreased more in centers where a provider had attended the training. Additional open-ended data about experiences with and barriers to deprescribing were collected and analyzed. The findings from this quality improvement project demonstrate that an educational intervention focused on providers practicing in the nursing home setting can improve deprescribing confidence and reduce polypharmacy rates. These findings may be used to implement similar deprescribing education programs for palliative care nurses and providers that prioritize goals of care for patients living with serious illness. [ABSTRACT FROM AUTHOR]

Fetal growth restriction (FGR) is a clinically important human pregnancy disorder that is thought to originate early in pregnancy and while its aetiology is not well understood, the disorder is associated with placental insufficiency. Currently treatment for FGR is limited by increased surveillance using ultrasound monitoring and premature delivery, or corticosteroid medication in the third trimester to prolong pregnancy. There is a pressing need for novel strategies to detect and treat FGR at its early stage. Homeobox genes are well established as master regulators of early embryonic development and increasing evidence suggests they are also important in regulating early placental development. Most important is that specific homeobox genes are abnormally expressed in human FGR. This review focusses on identifying the molecular pathways controlled by homeobox genes in the normal and FGR-affected placenta. This information will begin to address the knowledge gap in the molecular aetiology of FGR and lay the foundation for identifying potential diagnostic and therapeutic targets. • Homeobox genes comprise an important family of transcription factors. • Characterised by a well conserved DNA binding motif the "homeodomain". • Regulate the transcription of batteries of target gene expression and function. • Control cellular processes such as proliferation, differentiation, and apoptosis. • Placental homeobox genes are altered in human fetal growth restriction. [ABSTRACT FROM AUTHOR]

The need to improve existing structures has led to extensive research on strengthening techniques. Textile‐reinforced mortar (TRM) systems, which involve the integration of high‐strength fibers with inorganic matrix, have emerged as a highly promising and viable alternative. The objective of this research is to investigate the mechanical characteristics of inorganic mortar by examining different compositions involving sand, fibers, and cementitious materials. Various combinations were tested to evaluate their compressive strength, split tensile strength, and flexural strength. The findings indicated that a composite mixture (sample 12) comprising microsilica, silica sand, and optimized fibers demonstrated enhanced strength in all three assessments. Research highlights the significance of accurate mixing, additional components, and appropriate fibers to achieve intended performance of the mortar. The compatibility of the mortar is checked with substrate surface and textile sheet. Mortar is evaluated for splitting bond strength, slant shear test, direct pull‐off bond strength, and pull‐out strength. These results provide information about the strength and bonding characteristics of the mortar in different test scenarios. Values indicate how well the mortar performs with the substrate surface and the textile sheet under various types of stresses and loading conditions. [ABSTRACT FROM AUTHOR]

Prior research has shown that industry funding can impact the outcomes reported in medical literature. Limited data exist on the degree of bias that industry funding may have on shoulder arthroplasty literature outside of the Journal of Shoulder and Elbow Surgery. The purpose of this study is to characterize the type and frequency of funding for recently published shoulder arthroplasty studies and the impact of industry funding on reported outcomes. We hypothesized that studies with industry funding are more likely to report positive outcomes than those without. We performed a retrospective study searching all articles with the term "shoulder arthroplasty," "reverse shoulder arthroplasty," "anatomic total shoulder arthroplasty," or "total shoulder arthroplasty" on PubMed from the years January 2020 to December 2022. The primary outcome of studies was coded as either positive, negative, or neutral. A positive result was defined as one in which the null hypothesis was rejected. A negative result was defined as one in which the result did not favor the group in which the industry-funded implant was used. A neutral result was defined as one in which the null hypothesis was confirmed. Article funding type, subcategorized as National Institutes of Health funding or industry funding was recorded. Author disclosures were recorded to determine conflicts of interest. Statistical analysis was conducted using the χ2 test and Fisher exact test. A total of 750 articles reported on either conflict of interest or funding source and were included in the study. Of the total number of industry-funded studies, the majority were found to have a positive primary endpoint (58.1%, 104 of 179), as compared to a negative (7.8%, 14 of 179) or neutral endpoint (33.5%, 60 of 179) (P =.004). Overall, 363 articles reported an author conflict of interest, and the majority of these studies had positive primary endpoint (55.6%, 202 of 363) as compared to negative (9.1%, 33 of 363) or neutral endpoints (34.4%, 125 of 363) (P =.002). The results of this study suggest that there is a significant relationship between conflicts of interest and the primary outcome of shoulder arthroplasty studies, beyond the overall positive publication bias. Studies with industry funding and author conflicts of interest both report positive outcomes more frequently than negative outcomes. Shoulder surgeons should be aware of this potential bias when choosing to base clinical practice on published data. [ABSTRACT FROM AUTHOR]

Reducing differences in the gender representation of shoulder arthroplasty surgeons may help optimize patient care. This work aimed to determine (1) the current gender distribution of surgeons performing shoulder arthroplasty, (2) how gender relates to practice patterns among shoulder arthroplasty surgeons, and (3) how gender distribution has been changing over time. The Medicare Provider Utilization and Payment Data for the years 2012-2020 were used to identify orthopedic surgeons performing anatomic and reverse total shoulder arthroplasty (Current Procedural Terminology code 23472). The data set provides self-reported gender, credentials, National Provider Identifier, annual volume of all procedures (based on Current Procedural Terminology codes) that were performed ≥11 times in the calendar year, and location for all included providers. The data set was linked to the Medicare Physician Compare data set using National Provider Identifiers to determine hospital affiliations, year of medical school graduation, and graduating medical school. All included hospitals were queried to determine academic status (affiliated orthopedic residency or fellowship program). The American Shoulder and Elbow Surgeons (ASES) directory was reviewed to determine the gender breakdown of current members. The number of surgeons performing ≥11 shoulder arthroplasties annually increased from 821 (13 women [1.6%]) in 2012 to 1840 (53 women [2.9%], P =.05) in 2019. One female surgeon ranked in the top 100 surgeons by shoulder arthroplasty volume in 2012 and in 2020. Female surgeons graduated more recently from medical school (mean, 2005) compared with male surgeons (mean, 1997; P <.001). About 10% of female surgeons (10.8%, 12 of 111) and male surgeons (9.1%, 229 of 2528) practiced at hospitals with orthopedic residents (P =.50). Female surgeons performing shoulder arthroplasty were less likely than male surgeons to perform total knee arthroplasty (29.4% vs. 54.1%, P <.001) and total hip arthroplasty (12.6% vs. 34.7%, P <.001). There were 86 female members of ASES (6.7%, 86 of 1275), with a significant difference in the proportion of women in differing membership categories (P =.017). A diverse cohort of high-volume shoulder replacement surgeons is integral to delivering high-quality shoulder arthroplasty. Currently, the proportion of women performing high-volume shoulder replacement in the United States is small, with little improvement in recent years. However, women performing shoulder arthroplasty are younger and are often involved in academic practices, and the membership of ASES is increasingly female. Continued efforts to promote orthopedics—and to mentor female residents and medical students interested in shoulder surgery—may bring real change to the gender differences among shoulder replacement surgeons over the coming years. [ABSTRACT FROM AUTHOR]

This article describes a quality improvement project implemented by a national postacute long-term care organization aimed at enhancing the provision of palliative care to nursing home residents. The project focused on improving advance care planning, end-of-life care, symptom management, and care of people living with serious illness. Both generalist and specialist palliative care training were provided to nurse practitioners in addition to implementing a system to identify residents most likely to benefit from a palliative approach to care. To evaluate the nurse practitioner experiences of the program, survey data were collected from nurse practitioners (N = 7) involved in the project at 5 months after implementation. Nurse practitioners reported the program was well received by nursing home staff, families, and residents. Most nurse practitioners felt more confident managing residents' symptoms and complex care needs; however, some reported needing additional resources for palliative care delivery. Most common symptoms that were managed included pain, delirium, and dyspnea; most common diagnoses cared for were dementia and chronic organ failure (eg, cardiac, lung, renal, and neurological diseases). In the next steps, the project will be expanded throughout the organization, and person- and family-centered outcomes will be evaluated. [ABSTRACT FROM AUTHOR]

Particle-induced osteolysis resulting from polyethylene wear remains a source of implant failure in anatomic total shoulder designs. Modern polyethylene components are irradiated in an oxygen-free environment to induce cross-linking, but reducing the resulting free radicals with melting or heat annealing can compromise the component's mechanical properties. Vitamin E has been introduced as an adjuvant to thermal treatments. Anatomic shoulder arthroplasty models with a ceramic head component have demonstrated that vitamin E–enhanced polyethylene show improved wear compared with highly cross-linked polyethylene (HXLPE). This study aimed to assess the biomechanical wear properties and particle size characteristics of a novel vitamin E–enhanced highly cross-linked polyethylene (VEXPE) glenoid compared to a conventional ultrahigh-molecular-weight polyethylene (UHMWPE) glenoid against a cobalt chromium molybdenum (CoCrMo) head component. Biomechanical wear testing was performed to compare the VEXPE glenoid to UHMWPE glenoid with regard to pristine polyethylene wear and abrasive endurance against a polished CoCrMo alloy humeral head in an anatomic shoulder wear-simulation model. Cumulative mass loss (milligrams) was recorded, and wear rate calculated (milligrams per megacycle [Mc]). Under pristine wear conditions, particle analysis was performed, and functional biologic activity (FBA) was calculated to estimate particle debris osteolytic potential. In addition, 95% confidence intervals for all testing conditions were calculated. The average pristine wear rate was statistically significantly lower for the VEXPE glenoid compared with the HXLPE glenoid (0.81 ± 0.64 mg/Mc vs. 7.00 ± 0.45 mg/Mc) (P <.05). Under abrasive wear conditions, the VEXPE glenoid had a statistically significant lower average wear rate compared with the UHMWPE glenoid comparator device (18.93 ± 5.80 mg/Mc vs. 40.47 ± 2.63 mg/Mc) (P <.05). The VEXPE glenoid demonstrated a statistically significant improvement in FBA compared with the HXLPE glenoid (0.21 ± 0.21 vs. 1.54 ± 0.49 (P <.05). A new anatomic glenoid component with VEXPE demonstrated significantly improved pristine and abrasive wear properties with lower osteolytic particle debris potential compared with a conventional UHMWPE glenoid component. Vitamin E–enhanced polyethylene shows early promise in shoulder arthroplasty components. Long-term clinical and radiographic investigation needs to be performed to verify if these biomechanical wear properties translate to diminished long-term wear, osteolysis, and loosening. [ABSTRACT FROM AUTHOR]

Home health services provide patients with additional professional care and supervision following discharge from the hospital to theoretically reduce the risk of complication and reduce health care utilization. The aim of this investigation was to determine if patients assigned home health services following total shoulder arthroplasty (anatomic [TSA] and reverse [RSA]) exhibited lower rates of medical complications, lower health care utilization, and lower cost of care compared with patients not receiving these services. A national insurance database was retrospectively reviewed to identify all patients undergoing primary TSA and RSA from 2010 to 2019. Patients who received home health services were matched using a propensity score algorithm to a set of similar patients who were discharged home without services. We compared medical complication rates, emergency department (ED) visits, readmissions, and 90-day cost of care between the groups. Multivariate regression analysis was performed to determine the independent effect of home health services on all outcomes. A total of 1119 patients received home health services and were matched to 11,190 patients who were discharged home without services. There was no significant difference in patients who received home health services compared with those who did not receive home health services with respect to rates of ED visits within 30 days (OR 1.293; P =.0328) and 90 days (OR 1.215; P =.0378), whereas the home health group demonstrated increased readmissions within 90 days (OR 1.663; P <.001). For all medical complications, there was no difference between cohorts. Episode-of-care costs for home health patients were higher than those discharged without these services ($12,521.04 vs. $9303.48; P <.001). Patients assigned home health care services exhibited higher cost of care and readmission rates without a reduction in the rate of complication or early return to the ED. These findings suggest that home health care services should be strongly analyzed on a case-by-case basis to determine if a patient may benefit from its implementation. [ABSTRACT FROM AUTHOR]

Importance: Occupational therapy practitioners need evidence to support interventions that promote subjective well-being among autistic people and their families through optimal engagement and participation in occupations. Objective: These Practice Guidelines are informed by systematic reviews to expand knowledge of interventions that promote access, inclusion, engagement, and optimal participation in occupations that are meaningful to autistic people. Our intent was to foster occupational therapy practitioners' clinical decision-making and reasoning when working with autistic people and their care partners. Method: These Practice Guidelines were developed on the basis of four systematic reviews, supporting evidence and literature, along with continued revisions and integration through an iterative and collaborative process. Results: A total of 98 articles were included in the systematic reviews, which are the foundation for practice recommendations in these guidelines. Forty-eight of the systematic review articles were used to inform the clinical recommendations included in these Practice Guidelines. Conclusions and Recommendations: Strong to moderate evidence indicates the need for multidisciplinary, goal-oriented interventions to support autistic people in different contexts. Although there is only emerging evidence in the inclusion of autistic people's strengths, interests, and perspectives to guide occupational therapy interventions, such practices can enhance the delivery of neurodiversity-affirming and trauma-informed practices. In addition, evidence is needed to support participation in activities of daily living (ADLs) for autistic youths. We recommend the use of strengths-based language to describe autistic people and the use of environmental adaptations, care partner education, and coaching to enhance occupational therapy service delivery. Plain-Language Summary: The literature is sparse regarding neurodiversity-affirming and trauma-informed practices for autistic youths, as well as for participation in activities of daily living (ADLs). These Practice Guidelines provide new information on positive mental health development; self-determination; ADLs, instrumental ADLs, play, and leisure occupations for children, adolescents, and adults; person-centered planning for adolescents and adults; and rest and sleep. Information on health management is also provided. Positionality Statement: This article uses the identity-first language autistic people. This nonableist language describes their strengths and abilities and is a conscious decision. This language is favored by autistic communities and self-advocates and has been adopted by health care professionals and researchers (Bottema-Beutel et al., 2021; Kenny et al., 2016). However, we respect the use of person-first language and have made a conscious decision to include research articles that have used this language. These Practice Guidelines support interventions that promote access, inclusion, engagement, and optimal participation in occupations that are meaningful to autistic people across the lifespan. [ABSTRACT FROM AUTHOR]

Current standard total shoulder pegged glenoid component designs have a high rate of loosening, which accounts for the most common long-term reason for surgical failure. Glenoid design, method of fixation, and implantation version all play a role in component stability. This study aimed to evaluate the biomechanical stability of a novel circular glenoid with peripheral ring fixation and compare to a standard anchor pegged glenoid both directly and to historical biomechanical data. Additionally, we compared the estimated bone removal for the glenoid design types. Biomechanical testing was performed to assess the circular glenoid with peripheral ring fixation with regards to stability and resistance to "rocking horse" effect, torsional loosening, resistance to torque dissociation, and axial pullout strength. This was compared directly (pullout strength) and to historical ("rocking horse") biomechanical data obtained for a standard anchor pegged glenoid. A 3D Computer-Aided Design model of five different scapula sizes and shapes was also utilized to estimate volume bone removed when using implant specific prep instrumentation for each glenoid system. Tensile displacement of the worst-case ring fixation component (size medium) after dynamic rocking was 0.060 mm requiring an average peak torque of 6.21N-m to dissociate the glenoid. The ring fixation component demonstrated a mean pullout strength of 1367 N compared with 645 N for the standard anchor pegged glenoid component. The ring fixation component revealed no loosening when placed under torsional stress. The peripheral ring fixation glenoid preparation on average removed 45% less bone than a standard anchor pegged glenoid. The circular glenoid with peripheral ring fixation demonstrated superior maximum pullout strength and more bone preservation with glenoid preparation when compared to the standard pear-shaped, pegged glenoid components. Compared to published standard pegged glenoid component controls, the glenoid with peripheral ring fixation demonstrated diminished "rocking horse" displacement. Despite the circular anchor ring design, there was no evidence of loosening under torsional stress. Initial biomechanical data is overall promising for this novel glenoid design. [ABSTRACT FROM AUTHOR]

The B2 glenoid challenges the shoulder arthroplasty surgeon who must correct the substantial deformity to provide a well-functioning and lasting anatomic total shoulder arthroplasty. Careful evaluation of the B2 glenoid using 3-dimensional computed tomography imaging provides the most accurate information about the deformity to help guide the surgeon. Multiple surgical techniques and implant types can be used to correct the B2 glenoid deformity and achieve adequate support of the glenoid implant to prevent loosening and failure. Eccentric reaming can correct milder deformities, and posterior bone grafting and posterior augmented implants may allow for correction of larger deformities while still achieving good clinical outcomes. The recently developed zoned conformity glenoid may provide correction of glenoid retroversion and humeral head subluxation while achieving more stable fixation in the eroded glenoid vault. Finally, reverse shoulder arthroplasty is an option for the severe B2 glenoid. Despite the challenges of the B2 glenoid, good outcomes can be achieved with careful planning and the utilization of appropriate techniques. [ABSTRACT FROM AUTHOR]