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In recent years, the hype around Digital Twins (DTs) has been exponentially increasing in both industry and academia. DTs are a potential solution to increase automation and advance towards Smart Manufacturing. Manufacturing DTs have been implemented at different hierarchical levels, ranging from system of systems to unit level. Increasing computational capacity and data exchange rates can enable DT implementations for real-time applications. Several literature reviews on manufacturing DTs have been published. However, no previous paper focuses on manufacturing DTs at the unit level for which real-time control is most applicable. Simultaneously, the challenges to engineer DTs with real-time capabilities are enormous, both from a scientific and technological perspective. Therefore, we focus on DTs of single production units such as traditional machine tools, additive manufacturing machines and advanced robotic applications. In this systematic literature review, 96 papers about practical unit level DT applications found in the Scopus database using a combination of the keywords "Digital Twin", "Production" and "Manufacturing" are reviewed. We summarize how DTs are currently implemented and operated, and what potential benefits DTs offer at the unit process level in four categories: generic reference models, services, DT content (models and data) and DT deployment (hardware and software). Following the thematic analysis, an overall discussion, summary of key contributions and identified research gaps, and outlook into future research avenues is given. Key findings of this review can be summarized as: focus on DT components versus being holistic; need to share data and models across multiple stakeholders; lack of physical fidelity of the models; stark contrast of lab scale developments and real world testing, e.g., historical data and storage related challenges; lack of clear definition of DT in industry, and missing semantic interoperability between a wide variety of domains. [Display omitted] [ABSTRACT FROM AUTHOR]

Patients diagnosed with a cleft palate often have a congenitally missing maxillary lateral incisor. The congenital cleft presents the practitioner with challenges including the quantity and quality of bone, a surgically managed cleft correction, and limited clinical space. The purpose of the present prospective investigation was to report preliminary results at the 1-year follow-up for this planned 5-year investigation of narrow diameter implants used to restore a missing lateral incisor in patients with a cleft palate. Fourteen study participants with a cleft palate and a missing maxillary lateral incisor were enrolled based on established criteria. Narrow diameter implants (AstraTech OsseoSpeed TX 3.0S and 3.5 mm) were placed by using a 2-stage protocol and restored. All study participants received an Atlantis abutment and a cement-retained crown. Four probing depth measurements and bleeding on probing were measured at baseline and at 1 year. Probing depth measurements were evaluated using a 2-way repeated measures ANOVA with Tukey-Kramer multiple comparisons tests. Radiographic marginal bone loss was measured at 1-year by using a digital subtraction technique and evaluated by using a repeated measures ANOVA. Pretreatment cone beam computed tomography (CBCT) images were used to measure a mean gray level that was proportional to bone mineral density (BMD) in the implant site. One-way mixed ANOVA was used to compare the mean gray level and average implant stability quotient (ISQ) loading. A Pearson correlation was also tested between those parameters (α=.05) for each statistical analysis. The mean marginal bone loss at 1 year was 0.601 ±0.48 mm. Regarding probing depth measurements, a 2-way repeated measures ANOVA found both the location (P =.012) and time (P =.009) were significant. The Tukey-Kramer multiple comparisons test showed a significant difference between the buccal and distal site (P =.006) from baseline to 1-year follow-up. Narrow diameter implants are a reliable treatment for replacing a missing lateral incisor in patients with a cleft palate at 1 year, with an implant survival rate of 100% and implant success rate of 94% using the established criteria. A negative association was found between the bone mineral density and the implant stability in the alveolar cleft site of a patient with a cleft palate. The peri-implant soft tissue probe depths exhibited significant change during the first year. [ABSTRACT FROM AUTHOR]

Extreme weather has a direct and significant impact on buildings and infrastructure, resulting in billions of dollars of damage each year. This problem continues to grow as climate patterns change and buildings are exposed to new and different hazards than what they were designed to withstand. In order to better plan for the long-range sustainment, restoration, modernization, and eventual recapitalization of these buildings, organizations with large building portfolios, such as the U.S. Department of Defense (DoD), must have an awareness of the risks that these extreme weather events present. This research aimed to develop an approach to estimate condition loss and reduction in service life for the components of a building due to extreme weather hazards, to understand the risks that may be present in certain buildings and building systems. To achieve this objective, a damage association matrix was developed that categorizes climate hazards, the damage modes that they produce, and the individual component types impacted. This damage matrix formally links state-of-the-art climate model output, which provides projections of the probability of various climate hazards with a damage effects model that quantifies the consequence on component-level condition and service life. This method is applied to an actual portfolio of buildings in a particular geographic location and with a pre-defined component inventory that comprises the building. This approach can be aggregated to the system-, facility-, and site-level thus helping support billions of dollars in recapitalization decisions related to restoration/modernization of facilities. • The BUILDER Sustainment Management System forecasts facility conditions across the U.S. Department of Defense • Lifecycle assessment tools, like BUILDER, generally do not consider vulnerability to extreme weather and climate change. • We developed a plug-in for BUILDER that evaluates the impact of future extreme weather on facility lifespans and associated costs. [ABSTRACT FROM AUTHOR]

Despite limited evidence, technique efficacy and complications may be important short-term outcomes after ablation for hepatocellular carcinoma (HCC). We aimed to report these outcomes after ablation as the first surgical intervention for HCC. This nationwide cohort study was based on data from the Danish Liver and Biliary Duct Cancer Database and medical records. Variables associated with outcomes were investigated using logistic regression. From 2013 to 2023, 433 patients were included of which 79% were male, 73% had one tumor, and 90% had cirrhosis. Complete ablation was achieved after percutaneous, laparoscopic, and open approach in 84%, 100%, and 96% of the procedures, respectively. Most patients did not experience complications (76%). Open ablation compared with percutaneous was associated with higher risk of complications in multivariable adjusted analysis (Clavien-Dindo grade 2–5 (odds ratio 5.34, 95% confidence interval [2.36; 12.08]) and 3B-5 (5.70, [2.03; 16.01]), and lower risk of incomplete ablation (0.19 [0.05; 0.65]). Number of tumors ≥3 was associated with a higher risk of incomplete ablation (3.88, [1.45; 10.41]). Tumor diameter ≥3 cm was associated with increased risk of complications grade 2–5 (2.84, [1.29; 6.26]) and 3B-5 (4.44, [1.62; 12.13]). Performance status ≥2 was associated with risk of complications grade 3B-5 (5.98, [1.58; 22.69]). Tumor diameter was not associated with technique efficacy. Open ablation had a higher rate of complete ablation compared with percutaneous but was associated with a higher risk of complications. Tumor diameter ≥3 cm and performance status ≥2 were associated with a higher risk of complications. [ABSTRACT FROM AUTHOR]

Background: The objective was to investigate the feasibility of blood flow restricted exercise (BFRE) as a rehabilitation modality in patients with a unilateral ankle fracture.Methods: Feasibility study with a prospective cohort design. Inclusion criteria were above 18 years of age and unilateral ankle fractures.Exclusion Criteria: history of cardiac or embolic diseases, cancer, diabetes, hypertension and family history of cardio or vascular diseases. The predefined feasibility outcome was based on three criteria regarding patients experience with participating in the BFRE protocol and the absence of any serious adverse events.Results: Eight patients were included. Median age was 33 years (range: 23-60). All eight patients reported maximum satisfaction on the two questions regarding patient's perception of the overall experience with BFRE training and the feasibility to introduce BFRE as an intervention.Conclusion: Early use of BFRE in patients with unilateral ankle fractures seems feasible in patients without comorbidity. [ABSTRACT FROM AUTHOR]

Sugarcane mill ash has been suggested as having high potential for carbon dioxide removal (CDR) via enhanced weathering (EW), but this had not been quantitatively assessed. The aims of this study were to 1) assess the CDR potential of various sugarcane mill ashes via EW, and 2) investigate the impact of soil conditions and mill ash properties on the CDR. This was done by characterising physical and chemical properties of five mill ashes from Australia and simulating weathering using a one-dimensional reactive transport model. The model was parameterised to simulate weathering of 100 t/ha of wet ash (47–65% water) or crushed basalt for 15 years under various combinations of soil pH and carbon dioxide partial pressure (pCO 2). A sensitivity analysis was undertaken in a two-level factorial design to test the effect of pH, pH buffering, material surface area, infiltration rate, plant uptake of nutrients, organic matter cation exchange surfaces, and pCO 2 on modelled CDR. The simulated CDR of the mill ashes was significantly less than the basalt (p < 0.001) but mostly did not differ significantly between ashes (p > 0.05). Weathering of mill ash removed 0.0–4.0 t CO 2 /ha (0.00–0.040 t CO 2 /t wet ash) cumulatively, similar to some basalts and olivine modelled in the literature. The theoretical maximum CDR of the mill ashes (based on amount of weatherable material applied) was achieved in around 5 years. The estimate of CDR varied by orders of magnitude depending on conditions. It was least when initial soil solution pH was lowest (4.5, unbuffered), pH was at 6.5 or less with constant buffering, and pCO 2 was low (600 ppm). CDR was also significantly lower when calculated directly from accumulation of carbon in dissolved and solid phases rather than stoichiometrically from cation release. The effects of pH and pH buffering quantified here may explain low measured CDR from EW in field trials on acidic soils and highlight the need for more realistic modelling of pH buffering capacity. Overall, mill ash shows high potential for CDR via EW, especially if lifecycle benefits are considered, although this must be validated in the field. • 100 t/ha wet sugarcane mill ash may remove up to 4.0 t CO 2 /ha cumulatively. • Up to 99% of maximum carbon dioxide removal potential was achieved in ∼5 years. • Carbon dioxide removal is orders of magnitude less when pH is < 5.5 or buffered. • Carbon dioxide partial pressure increases carbon dioxide removal potential. • Carbon dioxide removed by mill ash similar to other modelled materials and field data. [ABSTRACT FROM AUTHOR]

Knowledge of the normal size of the urethral meatus in boys is important for safely performing urethral catheterization and fundamental to the diagnosis and treatment of paediatric urological conditions. However, clinicians often rely subjectively on previous experience and clinical judgement, rather than a robust evidence-base. A systematic review of the literature was undertaken to define the calibre of the male urethral meatus in paediatric age-groups. The MEDLINE and EMBASE databases were systematically searched from inception to December 2020 for studies measuring meatal calibre in boys up to 16 years of age. Google Scholar searches along with forward and backward citation tracking identified additional studies. Studies of subjects >16 years, females, or patients with urethral diseases were excluded. Nine articles (2084 paediatric subjects) were included in the final review. Mean meatal calibre increases non-linearly with age, with accelerated growth occurring during infancy (mini-puberty) and adolescence (puberty). Meatal calibre can be approximately grouped by age as follows: neonate (6-10Fr); infant (10-12Fr); child (12-14Fr); and adolescent (14-18Fr). There is substantial individual variability for same-aged children. Meatal calibre has been independently related to height, weight, and penile size, but the effects of ethnicity and circumcision remain unclear. The evidence-base for this fundamental aspect of paediatric urology includes only a few low-quality studies and is largely derived from one early study of circumcised American boys. Further studies are warranted to establish normative urethral size values based on rigorous, contemporary data with known dependent variables also included. [ABSTRACT FROM AUTHOR]

• A number of studies have linked Alu retrotransposon-mediated molecular processes to circadian gene expression pathways. • We review the evidence indicating Alu RNAs are essential for posttranscriptional regulation of circadian gene expression. • Alus likely participate in the organization of circadian brain function, operating in multidimensional neuroepigenetic space. • Perturbations of Alu -centric posttranscriptional pathways likely contribute to the manifestation of neurological disease. The circadian rhythm of the human brain is attuned to sleep-wake cycles that entail global alterations in neuronal excitability. This periodicity involves a highly coordinated regulation of gene expression. A growing number of studies are documenting a fascinating connection between primate-specific retrotransposons (Alu elements) and key epigenetic regulatory processes in the primate brain. Collectively, these studies indicate that Alu elements embedded in the human neuronal genome mediate post-transcriptional processes that unite human-specific neuroepigenetic landscapes and circadian rhythm. Here, we review evidence linking Alu retrotransposon-mediated posttranscriptional pathways to circadian gene expression. We hypothesize that Alu retrotransposons participate in the organization of circadian brain function through multidimensional neuroepigenetic pathways. We anticipate that these pathways are closely tied to the evolution of human cognition and their perturbation contributes to the manifestation of human-specific neurological diseases. Finally, we address current challenges and accompanying opportunities in studying primate- and human-specific transposable elements. [ABSTRACT FROM AUTHOR]

This is a cross-sectional study among 600 patients. Isolated hand and forearm injuries or conditions are common in the emergency and orthopedic departments. So far, little is known about whether these patients suffer from concurrent musculoskeletal complaints (MSCs) besides their hand and forearm complaints. Neglecting concurrent MSCs in the upper limbs and necks could hamper rehabilitation and prolong the time taken to return to daily and work-related activities. The purpose of this study was to investigate the prevalence of concurrent MSCs in the elbow, shoulder, and neck after common hand and/or forearm injuries or conditions. This study included 600 patients with any type of diagnosis referred to rehabilitation after hand and/or forearm injuries or conditions. Basic characteristics, diagnoses, and location of patients' symptoms were collected and analyzed. The overall prevalence of concurrent MSCs was 40%. Twenty-eight percent of the whole sample developed concurrent MSCs after the hand and forearm injury or condition. The gender distribution was 68% women and 32% men. The most common location for complaints was the shoulder (62%), followed by the elbow (49%), and the neck (32%). The present results suggest that MSCs from the elbows, shoulders, or necks are very common in patients with hand and/or forearm injuries or conditions. Clinicians treating patients with isolated hand and forearm injuries or conditions should be aware of the high prevalence of concurrent MSCs. Future research should investigate if specific rehabilitation, focusing on concurrent MSCs, may influence the outcome in this population. • Prevalence of concurrent MSCs in patients with hand/forearm injury or condition. • The prevalence of concurrent MSCs in elbows, shoulders, and necks was 40% in this population. • More than one in four patients developed MSCs after their hand/forearm injury or condition. • Clinicians should be aware of the high prevalence of concurrent MSCs. [ABSTRACT FROM AUTHOR]

Introduction: Despite fractures of the ankle being very common, there is a lack of clarity regarding the relative effectiveness of conservative versus surgical treatment. The purpose of this systematic review and meta-analysis was to investigate the clinical effects, benefits, and harms of surgical versus conservative treatment of ankle fractures in adults.Methods: A systematic search strategy was conducted in the databases: Pubmed, Embase, Web of Science, and Cochrane up until the 16th of August 2017. Eight available randomized controlled trials, regardless of fracture type, reported on patient-reported ankle-specific functional outcome and were included. Analyses were based on random effects models.Results: The 8 included studies randomly allocated 1237 patients to either surgical or conservative treatment. Mean age of patients ranged from 38.1 to 71.4 years. Five studies evaluated short-term patient-reported ankle function, with no significant difference between surgery and conservative treatment (SMD=-0.14, 95%CI=-0.57 to 0.29, P=0.51, I2=84%). Three studies evaluated health-related quality of life, with no significant difference in treatment effect between surgery or conservative treatment (SMD=0.13, 95%CI=-0.01 to 0.27, P=0.06, I2=0%).Conclusions: The best available current evidence supports that clinicians can manage ankle fractures by both surgical and conservative means with equal short-term results in selected patient groups with stable and unstable nondisplaced ankle fractures. However, more research is needed including high-quality RCTs investigating the long-term effects. This is especially the case in younger patients, before making significant interpretations about clinical practice. [ABSTRACT FROM AUTHOR]

Background: Portal vein occlusion (PVO) is an established method to increase the volume of the future liver remnant (FLR). The main reasons for not proceeding to radical hepatectomy are lack of volume increase and tumor progression due to a wait-time interval of up to 8 weeks. The hypothesis was that the increase in FLR volume is not linear and is largest during the first weeks.Methods: Patients with colorectal liver metastases (CRLM) and standardized future liver remnant (sFLR) < 30% treated with PVO were prospectively included. All patients had at least one CT evaluation before radical hepatectomy.Results: Forty-eight patients were included. During the first week after PVO, the kinetic growth rate (KGR) was 5.4 (± 4), compared to 1.5 (± 2) between the first and second CT (p < 0.05). For patients reaching adequate FLR and therefore treated with radical hepatectomy, the KGR was 7 (± 4) the first week, compared to 4.3 (± 2) for patients who failed to reach a sufficient volume (p = 0.4). During the interval between the first and second CT, the KGR was 2.2 (± 2), respectively (± 0.1) (p = 0.017).Discussion: The increase in liver volume after PVO is largest during the first week. As KGR decreases over time, it is important to shorten the interval between PVO and the first volume evaluation; this may aid in decision-making and reduce unnecessary waiting time. [ABSTRACT FROM AUTHOR]

Introduction: The modern literature includes only limited information regarding mortality rates and cumulative survival following patella fractures. The aim was to report the 30-day, six-month, and one-year mortality of patients with patella fractures and compare this to the mortality of a matched reference population.Methods: All patients who sustained a patella fracture in Denmark between 1996 and 2000 were included in the study. The survival status of these patients was monitored until 2015. We compare the mortality with a ten-fold reference population matched on age and gender without a prior patella fracture.Results: 6096 patients were treated for 6114 patella fractures. The mean age of patients was 48.9 years. The overall mortality rates at 30 days, six months, and one year were 0.7%, 1.8%, and 2.8%. The mortality rates for patients > 65 years at 30 days, six months, and one year were 1.3%, 3.9%, and 6.2%. The mortality rates for patients at ≤ 65 years at 30 days, six months, and one year were 0.4%, 0.9%, and 1.3%. Compared to the matched reference population, the relative risk of mortality in patients > 65 years at 30 days, six months, and one year were 1.9 (95% CI 1.2-2.9), 1.0 (95% CI 0.8-1.3), and 0.9 (95% CI 0.7-1.1).Conclusion: The overall one-year mortality rate of patella fractures was 2.8% and this was increased to 6.2% in patients older than 65 years. In elderly patients above 65 years, the relative risk of death was 0.9, indicating that patella fractures in elderly patients were not associated with an increased mortality rate. [ABSTRACT FROM AUTHOR]