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Introduction: Orthopaedic surgery has consistently been one of the most competitive specialties in the US residency selection process. This is due in part to the steady upward trend in average applications received per program and average applications submitted per applicant, which is of growing concern. With the implementation of the Preference Signaling Program, the total number of applications has now dropped for the first time in many years, indicating signaling may improve the application process. The hypothesis is that signaling has led to a decrease in applications sent by applicants and a decrease in applications received by programs., Methods: A 7-question survey regarding their interview and match statistics was sent to orthopaedic surgery residency programs that participated in the Electronic Residency Application Service during the 2023-2024 application cycle. A response from the program director/administrator was then recorded., Results: Our program search yielded 159 programs with 106 respondents (66.7%). 82 programs (78.8%) solely interviewed applicants who signaled their program. 92.7% of current interns signaled the program where they matched, and 88 programs (84.6%) matched only applicants who signaled. 95 programs (89.6%) revealed that implementing signaling has improved the application process., Conclusion: Most of the programs only interviewed applicants who also signaled, and nearly all matched orthopaedic surgery applicants from the 2022-2023 cycle signaled their matching program. Orthopaedic surgery applicants should consider only applying to 30 programs and using all 30 available signals. Applicants should also be more confident knowing that beyond the 30 signals they use, there is limited support to say that they will receive an interview outside of these 30 applications. Orthopaedic surgery programs will also now have the ability to allocate more time to applicants most interested in their program, given the reduction of applications., (Copyright © 2024 by the American Academy of Orthopaedic Surgeons.)

Objectives: Alzheimer's disease (AD) is a progressive neurodegenerative disorder affecting approximately 55 million individuals globally. Diagnosis typically occurs in advanced stages, and there are limited options for reversing symptoms. Preventive strategies are, therefore, crucial. Time Restricted Eating (TRE) or Time Restricted Feeding (TRF) is one such strategy. Here we review recent research on AD and TRE/TRF in addition to AD biomarkers and gut microbiota. Methods: A comprehensive review of recent studies was conducted to assess the impact of TRE/TRF on AD-related outcomes. This includes the analysis of how TRE/TRF influences circadian rhythms, beta-amyloid 42 (Aß42), pro-inflammatory cytokines levels, and gut microbiota composition. Results: TRE/TRF impacts circadian rhythms and can influence cognitive performance as observed in AD. It lowers beta-amyloid 42 deposition in the brain, a key AD biomarker, and reduces pro-ininflammatory cytokines. The gut microbiome has emerged as a modifiable factor in AD treatment. TRE/TRF changes the structure and composition of the gut microbiota, leading to increased diversity and a decrease in harmful bacteria. Discussion: These findings underscore the potential of TRE/TRF as a preventive strategy for AD. By reducing Aß42 plaques, modulating pro-inflammatory cytokines, and altering gut microbiota composition, TRE/TRF may slow the progression of AD. Further research is needed to confirm these effects and to understand the mechanisms involved. This review highlights TRE/TRF as a promising non-pharmacological intervention in the fight against AD. [ABSTRACT FROM AUTHOR]

Background: Posterior malleolus fractures may be fixed to restore syndesmosis stability. However, these fractures are often accompanied by ruptures of other ligaments that stabilize the syndesmosis. This study investigates the frequency of anterior syndesmosis injury in posterior malleolus fractures and its effect on rotational stability. Methods: Seventy-five consecutive patients who underwent surgery for ankle fractures involving posterior malleolus were prospectively included. Preoperative computed tomography scans in two planes (transverse and sagittal) were used to assess the presence and size of avulsion fractures (LeFort-Wagstaffe and Tillaux-Chaput). Intraoperatively, anterior syndesmosis injuries and rotational stability (determined via the external rotation test) were assessed through direct visualization. Results: In 73 patients (97%), a complete injury of the anterior tibiofibular ligament was observed intraoperatively, manifesting as avulsion fractures (8%), ligament injuries (44%), or a combination of both (45%). The mean dimensions of the avulsion fractures were 12.6 mm × 7.5 mm for LeFort-Wagstaffe fractures and 12.4 mm × 7.9 mm for Tillaux-Chaput fractures. Posterior malleolus fractures were stabilized in 57 patients. In 52 of these cases (92%), syndesmosis instability in the direction of external rotation persisted despite fixation of the posterior malleolus. Conclusions: Fixation of posterior malleolus fractures is rarely sufficient to fully restore syndesmosis stability. Post-fixation assessment of syndesmosis stability, particularly in external rotation, is essential. [ABSTRACT FROM AUTHOR]

Context: Medical education in the United States has undergone significant changes, specifically within the osteopathic community. In 2020, a merger occurred between the American Osteopathic Association (AOA) and the Accreditation Council for Graduate Medical Education (ACGME), forming a single accreditation system (SAS) for graduate medical education and residency placement, with the purpose to create consistency within graduate medical education and to provide equal opportunities for applicants pursuing all specialties in medicine. However, osteopathic medical students, especially students applying to competitive residencies including orthopedic surgery, have faced challenges, raising concerns about future implications within this field., Objectives: The main objective of this study aimed to investigate recent match rate trends in orthopedic surgery within the past 5 years and to forecast match trends for both allopathic and osteopathic students to further analyze the future projection of the orthopedic surgery match., Methods: This study utilized publicly available data from the National Residency Match Program (NRMP) Main Residency Match data. Data were collected retrospectively from 2020 to 2024 regarding students applying for orthopedic surgery residency. The number of matched Doctor of Osteopathic Medicine (DO) applicants, Doctor of Medicine (MD) applicants, overall applicants, and the proportion of matched applicants being DOs were forecasted over the next 10 years utilizing an Autoregressive Integrated Moving Average (ARIMA) model in SPSS 29.0. This model harvests data from previous instances (number of matched applicants from 2008 to 2024) to develop a close-fit model to predict future values and their respective confidence intervals (CIs). This study incorporated all applicants applying to orthopedic surgery, including international medical graduates (IMGs)., Results: There was an increase in the total applicants applying to orthopedic surgery residency positions for both allopathic and osteopathic students. The largest increase in applicants occurred between the 2021 and 2022 application cycles. There was a statistically significant difference in the total number of applicants overall over the 2020-2024 match cycle. The percentage of DOs to match into an orthopedic surgery residency position decreased from 63.28 % in 2020 to 45.70 % in 2024, and there was a statistically significant decline in the match percentage of DOs in orthopedic surgery residency over the 2020-2024 match cycle. Based on the ARIMA model projection utilizing data from 2008 to 2024, there is expected to be an average increase of 14.1 % in the total number of positions offered by 2034, to 1,045 positions total. There is expected to be a moderate increase in the number of matched DO applicants, from 128 in 2024 to 161 in 2034. Utilizing data from 2016 to 2024, there is expected to be an average increase of 10.7 % in the total number of positions offered by 2034, leading to a decreased proportion of positions filled by DO applicants by 2034, from 14.0 % in 2024 to 12.2 % by 2034., Conclusions: Osteopathic students continue to face challenges despite progress in DO representation within orthopedic surgery. We hope to provide insight into the growing competitiveness of orthopedic surgery programs and to describe future trends in DO match rates to aid students pursuing this field., (© 2024 the author(s), published by De Gruyter, Berlin/Boston.)

Wildfires have become larger and more severe in recent decades. Fire retardant is one of the most common wildfire response tools to protect against loss of life and property. Previous studies have documented various effects of fire retardant, which commonly contains chemicals used in fertilizers, on plant and invertebrate community composition. This mesocosm study investigated the effects of fire retardant on water quality and plant and invertebrate communities in California vernal pools. This study found that fire retardant caused water quality conditions to shift from oligotrophic to eutrophic with strong correlations between fire retardant and phosphates, nitrates, conductivity, and chlorophyll-a. Algal cover increased with added fire-retardant concentration. Shifts in invertebrate and plant communities occurred even at relatively low fire-retardant concentrations. Abundance of passive dispersers (crustaceans) peaked at medium concentrations of fire retardant, but time also influenced the relationship between fire retardant and passive invertebrate abundance. Active disperser (insects) abundance increased with increasing fire-retardant concentration and invertebrate richness peaked at medium concentrations. This study informs land managers, government agencies, and the public of the side-effects of fire-retardant use on populations, communities, and water quality of freshwater ecosystems., Competing Interests: Compliance with ethical standards. Conflict of interest: The authors declare no competing interests., (© 2025. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Rates of depression among youth and emergency department (ED) visits for un- or under-treated symptoms are on the rise. Early identification and treatment of depression is imperative at the patient, program, system, and population levels. This paper examines the individual and cumulative impact of Project ECHO and the inclusion of IBH services in pediatric primary care practices on mental health-related ED rates among youth diagnosed with depression for those practices. Twenty-eight practices participated and provided data on 5,388 patients diagnosed with depression who were seen between 2019 and 2022. A binominal mixed effect model was used to examine the impact of Project ECHO and IBH on mental health-related ED rates among youth diagnosed with depression per month within each practice. Compared to practices without an IBH program, those who implemented IBH had a significantly lower rate of mental health-related ED visits among this patient population (Incident Rate Ratio (IRR) = 0.80, p = .005, 95% Confidence Intervale (CI) = 0.68, 0.93). No significant differences were found between practices regardless of participation in Project ECHO, nor was there a significant interaction effect between practices that employed Project ECHO and IBH in combination. This study shows promising results with IBH having a positive impact on practice outcomes compared to treatment as usual, while Project ECHO in isolation or combined with IBH did not significantly affect rates of mental health-related ED visits., Competing Interests: Declarations. Ethics Approval: This study followed the STROBE reporting guidelines endorsed by the Enhancing the Quality and Transparency of Health Research (EQUATOR) Network. Conflict of Interest: The authors declare no conflicts of interest., (© 2024. National Council for Mental Wellbeing.)

Background: The association between aspirin and hepatocellular carcinoma (HCC) has been reported to prevent carcinogenesis caused by hepatitis B or C virus infection. The objective of this study was to investigate the prognostic impact of aspirin in patients who underwent liver resection for HCC., Methods: Data for 1032 patients who underwent primary resection for HCC between 2000 and 2019 were reviewed. There were 87 patients (8.4%) who took aspirin (aspirin group) and 945 (91.6%) who did not (non-aspirin group). Short-term outcomes, recurrence-free survival (RFS), and overall survival (OS) were compared between two groups in the matched cohort using propensity-score matching., Results: The median patient follow-up was 42.6 months (95% confidence interval 3.12-136.8 months). There was no significant difference in short-term outcomes, including bleeding events. RFS and OS after liver resection in the aspirin group were significantly better than those in the non-aspirin group in the unmatched cohort [5-year RFS rate: 50.3% vs 31.4%, hazard ratio (HR) 0.55, P = 0.0002; 5-year OS rate: 82.9% vs 70.2%, HR 0.46, P = 0.002]. In the matched cohort, RFS and OS after liver resection in the aspirin group were also significantly better than those in the non-aspirin group (5-year RFS rate: 50.3% vs 32.0%, HR 0.60, P = 0.003; 5-year OS rate: 82.9% vs 74.6%, HR 0.56, P = 0.03)., Conclusion: Use of aspirin was associated with better prognosis for patients who underwent primary resection for HCC., Competing Interests: Declarations. Conflict of interest: The authors have no conflicts of interest to declare., (© 2024. The Author(s) under exclusive licence to Japan Society of Clinical Oncology.)

Background: Successfully matching into orthopaedic surgery residency is a challenging endeavor due to the limited number of available positions. Implementation of the Standard Letter of Recommendation (SLOR) in 2017 was intended to allow better comparisons between applicants; however, the form suffered from notable rank inflation ultimately requiring introduction of an updated SLOR for the 2023 to 2024 application cycle. The purpose of this study was to evaluate whether the 2023 SLOR improves on deficiencies of the 2017 SLOR., Methods: Applications submitted to our institution during the 2023 to 2024 orthopaedic surgery residency application cycle were analyzed. Applicant objective metrics were collected, including US Medical Licensing Exam scores, clerkship grades, AΩA status, and research productivity. Scores for each domain of the 2023 SLOR forms were recorded. Mean scores were calculated for each question, and cumulative scores per SLOR were determined. Intraclass correlation coefficients were determined per applicant and evaluator. The Spearman rank correlation coefficient was calculated for comparison of SLOR cumulative scores and objective metrics., Results: Three hundred sixty-eight applications were reviewed, and 743 2023 SLORs were submitted in conjunction with these applications. Most of the 2023 SLORs (n = 399, 53.70%) had cumulative scores placing applicants in at least the 90th percentile. Furthermore, 267 evaluators (72.36%) consistently gave scores of 99s and 10s for each question. Intraclass correlation coefficients were rated as fair to moderate agreement between evaluators for each applicant. Objective applicant metrics did not meaningfully correlate with SLOR cumulative scores., Discussion: The 2023 SLOR demonstrated notable rank inflation with only 22.7% of applicants receiving a score of less than 7 on any domain. By contrast, 69.9% of applicants received a score of "rare, perfect gem" on at least one domain of the form. We encourage the American Orthopaedic Association Council of Orthopaedic Residency Director to continue to improve the form and provide guidance to residency program leadership on proper use of the grading system., (Copyright © 2024 by the American Academy of Orthopaedic Surgeons.)