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BACKGROUND: The orthopaedic surgery residency program website represents a recruitment tool that can be used to demonstrate a program’s commitment to diversity and inclusion to prospective applicants. The authors assessed how orthopaedic surgery residency programs demonstrated diversity and inclusion on their program websites and whether this varied based on National Institutes of Health (NIH) funding, top-40 medical school affiliation, university affiliation, program size, or geographic region. METHODS: The authors evaluated 187 orthopaedic surgery residency program websites for the presence of 12 elements that represented program commitment to diversity and inclusion values, based on prior work and ACGME recommendations. Mann-Whitney U and Kruskal-Wallis tests were used to assess whether NIH funding and other program characteristics were associated with commitment to diversity and inclusion on affiliated residency websites. RESULTS: Orthopaedic surgery residency websites included a mean of 4.9 ± 2.1 diversity and inclusion elements, with 21% (40/187) featuring a majority (7+) of elements. Top 40 NIH funded programs (5.4 ± 2.0) did not have significantly higher website diversity scores when compared with nontop-40 programs (4.8 ± 2.1) (P = 0.250). University-based or affiliated programs (5.2 ± 2.0) had higher diversity scores when compared with community-based programs (3.6 ± 2.2) (P = 0.003). CONCLUSIONS: Most orthopaedic surgery residency websites contained fewer than half of the diversity and inclusion elements studied, suggesting opportunities for further commitment to diversity and inclusion. Inclusion of diversity initiatives on program websites may attract more diverse applicants and help address gender and racial or ethnic disparities in orthopaedic surgery. LEVEL OF EVIDENCE: Level V

Host-generated property images as a visual channel reveal substantial information about properties. Selecting proper images to display can lead to higher demand and increased rental revenue. In this paper, we define, estimate, and optimize the impacts of Airbnb photos on customers’ renting decisions. We apply ResNet-50, a convolutional neural network model, to build two separate, supervised learning models to evaluate the image quality and room types posted by Airbnb hosts. Then, we characterize the overall impacts of photo layout by the room type featured in the photo, photo quality, and order of display on the listings’ web pages. To address two estimation challenges in the Airbnb setting, namely, censored demand and changing consideration sets, we propose a novel pairwise comparison model that utilizes customers’ booking sequence data to consistently estimate the impact of photo layout on customers’ renting decisions. Our estimation results suggest that the cover image has a significantly larger impact than noncover photos and a high-quality bedroom cover image leads to the largest increase in demand. Furthermore, we build a nonlinear integer programming optimization problem and develop an algorithm to determine the optimal photo layout. Our counterfactual analysis suggests that a listing’s unilateral adoption of optimal photo layout leads to 11.0% more bookings on average. Moreover, depending on the neighborhood and market size, when listings simultaneously switch to the optimal photo layout, they get booked for two to five additional days in a year on average, which boosts revenue by $500 to $1,100. This paper was accepted by Swaminathan, Jayashankar, operations management. Funding: This research was partially sponsored by the MIT Data Science Lab, and also benefited from generous support provided by Zalando. Supplemental Material: The online companion and data are available at https://doi.org/10.1287/mnsc.2022.4616 .

BACKGROUND: Osteoarthritis is a chronic musculoskeletal condition that frequently affects the hip and knee joints. Given the burden associated with surgical intervention for hip and knee osteoarthritis, patients continue to search for potential non-operative treatments. One biologic therapy with mixed clinical and basic science evidence for treating osteoarthritis is platelet-rich plasma injections into the affected joint. We used the Google Trends tool to provide a quantitative analysis of national interest in platelet-rich plasma injections for hip and knee osteoarthritis. METHODS: Google Trends parameters were selected to obtain search data from January 2009 to December 2019. Various combinations of ‘arthritis’, ‘osteoarthritis’, ‘PRP’, ‘platelet-rich plasma’, ‘knee’, and ‘hip’ were entered into the Google Trends tool and trend analyses were performed. RESULTS: Three linear models were generated to display search volume trends in the United States for platelet-rich plasma and osteoarthritis, hip osteoarthritis, and knee osteoarthritis, respectively. All models showed increased Google queries as time progressed (p < 0.001), with R(2) ranging from 0.837 to 0.940. Seasonal, income-related, and geographic variations in public interest in platelet-rich plasma for osteoarthritis were noted. CONCLUSION: Our results demonstrate a significant rise in Google queries related to platelet-rich plasma injections for osteoarthritis of the hip and knee since 2009. Surgeons treating hip and knee osteoarthritis patients can expect continued interest in platelet-rich plasma, despite inconclusive clinical and basic science data. Trends in public interest may inform patient counseling, shared decision-making, and directions for future clinical research.

Objective To evaluate the rate of surgery for symptomatic malunion after nonoperatively treated distal radius fractures in patients aged 55 and above, and to secondarily report differences in demographics, geographical variation, and utilization costs of patients requiring subsequent malunion correction. Methods We identified patients aged 55 and above who underwent nonoperative treatment for a distal radius fracture between 2007 and 2016 using the IBM MarketScan database. In the nonoperative cohort, we identified patients who underwent malunion correction between 3 months and 1 year after distal radius fracture. The primary outcome was rate of malunion correction. Multivariable logistic regression controlling for sex, region, and Elixhauser Comorbidity Index (ECI) was used. We also report patient demographics, geographical variation, and utilization cost. Results The rate of subsequent malunion surgery after nonoperative treatment was 0.58%. The cohort undergoing malunion surgery was younger and had a lower ECI. For every 1-year increase in age, there was a 6.4% decrease in odds of undergoing surgery for malunion, controlling for sex, region, and ECI (odds ratio = 0.94 [0.93–0.95]; p Conclusion The rate of surgery for symptomatic malunion after initial nonoperative treatment for distal radius fractures in patients aged 55 and above is low. As younger and healthier patients are more likely to undergo malunion correction with higher associated costs, surgeons may consider offering this cohort surgical treatment initially.

Background: Both natural grass (NG) and artificial turf (AT) are popular playing surfaces for soccer. Biomechanical studies have found increased frictional forces on AT that may lead to anterior cruciate ligament (ACL) injury. The increased risk of ACL injury during soccer in female participants may amplify this effect. Purpose: To systematically review the literature for studies comparing ACL injury risk in soccer players on AT versus NG and to specifically determine whether there were differences in injury risk in male versus female players when considering the playing surface. Study Design: Systematic review; Level of evidence, 3. Methods: A systematic review was performed using PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Three databases were searched for studies with evidence level 1 to 3 that compared the incidence of ACL injuries on AT versus NG in soccer players. Data recorded included study characteristics, sex, competition level, exposure setting (games or practices), turf type, and ACL injury information. Study methodological quality was analyzed using the methodological index for non-randomized studies (MINORS) score, and incidence rate ratios (IRRs) were calculated. Results: Included were 7 articles (3 studying professional soccer, 3 collegiate soccer, 1 youth-level soccer; 4 male cohorts, 2 female cohorts, and 1 male and female cohort; mean MINORS score, 20 ± 0.8). Pooled ACL injury IRRs demonstrated no significant differences in overall ACL injury risk when playing soccer on AT compared with NG (IRR = 0.57 [95% CI, 0.21-1.53]; P = .31). A significantly increased risk of ACL injury in games played on AT compared with NG was detected for female (IRR = 1.18 [95% CI, 1.05-1.31]; P = .004) but not for male players (IRR = 1.18 [95% CI, 0.97-1.42]; P = .09). Subgroup analyses showed no significant differences in injury risk for games (IRR = 1.07 [95% CI, 0.97-1.18]; P = .20) or practices (IRR = 0.21 [95% CI, 0.04-1.23]; P = .09). Conclusion: Findings indicated that female soccer players had a significantly higher risk of ACL injury when playing games on AT versus NG, whereas no significant difference was seen in male players. No differences were found for the combined male/female cohort or for soccer games or training sessions played on AT compared with NG.

Background: Abnormal scaphoid alignment after fracture is used as an indication for fixation. Acceptable alignment after reduction and fixation of scaphoid fractures is not well defined. We systematically reviewed the literature to identify how scaphoid malunion is currently defined and by what parameters. Methods: A systematic review was performed using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Multiple databases were searched for studies published in the English language that reported on outcomes after scaphoid malunion and included measurements to define malunions. Radiographic scaphoid measurement parameters were collected. Clinical outcome measures recorded included grip strength, wrist range of motion, and patient-reported outcome measures. Study quality was analyzed using the Methodological Index for Non-Randomized Studies (MINORS) criteria. Descriptive summaries of the studies are presented. Results: The initial search yielded 1600 articles. Ten articles (161 participants, 93% males, mean age = 28.3 + 6.3 years, mean MINORS score = 10.2 + 1.6) were included and analyzed. Scaphoid malunion was defined if the lateral intrascaphoid angle (LISA) was >45° (3 articles), LISA >35° (1 article), and height to length ratio >0.6 (3 articles). Four out of 5 studies found no significant associations between patient outcomes and degree of scaphoid malunion measured on imaging. Conclusions: There is a lack of consensus for defining scaphoid malunion on imaging and absence of correlation between findings on imaging and patient outcomes. Future studies defining scaphoid malunion should be appropriately powered, incorporate measures of intrarater and interrater reliabilities for all reported imaging measurements, and utilize validated patient-reported outcome measures to reflect that malunion is associated with inferior outcomes meaningful to patients.

Background The purpose of this study was to determine whether patients undergoing any shoulder arthroscopic procedure with concomitant biceps tenodesis have higher reoperation and complication rates vs. patients undergoing shoulder arthroscopy without concomitant biceps tenodesis. Methods A large database was queried for patients undergoing shoulder arthroscopy, identified by Current Procedural Terminology code. Only records indicating the laterality of the procedure were included. Patients were divided into 3 cohorts: arthroscopic shoulder surgery without concomitant biceps tenodesis (group 1), surgery with arthroscopic biceps tenodesis (group 2), and surgery with open biceps tenodesis (group 3). Reoperations on the same shoulder, as well as medical or surgical complications (by International Classification of Diseases, Ninth Revision code) during the 30-day postoperative period, were determined. Multivariate logistic regression was used to control for differences in age, sex, and Charlson Comorbidity Index between groups. Results We identified 62,461 patients (54.3% male patients) in the database who underwent shoulder arthroscopy, with 51,773 patients in group 1, 7134 patients in group 2, and 3554 patients in group 3. Overall, 3134 patients (5.0%) underwent a shoulder arthroscopy reoperation. With adjustment for age, sex, and Charlson Comorbidity Index, the biceps intervention groups demonstrated a significantly higher overall reoperation rate (odds ratio, 1.3 [95% confidence interval, 1.2-1.5]; P < .001). Patients undergoing biceps tenodesis had a lower adjusted overall 30-day complication rate vs. those not undergoing tenodesis (odds ratio, 0.82 [95% confidence interval, 0.79-0.86]; P < .001). Conclusion Reoperation rates were significantly higher in patients undergoing shoulder arthroscopy with biceps tenodesis than in patients undergoing shoulder arthroscopy without biceps tenodesis. Both the arthroscopic and open tenodesis groups had significantly lower complication rates.

Objectives: Both natural grass (NG) and artificial turf (AT) are popular playing surfaces for soccer. Biomechanical studies have found increased frictional forces on artificial turf that may lead to anterior cruciate ligament (ACL) injury. Few studies have examined the differences between ACL injury risk in male and female soccer athletes playing on AT versus NG. Given the higher risk for female ACL injury in sports, and soccer in particular, it is important to define whether AT may compound this injury risk. The purpose of this investigation was to systematically review the literature for studies comparing ACL injury risk on AT versus NG in soccer, and to specifically determine if there were differences in injury risk in males versus females when considering the playing surface. Methods: A systematic review was pre-registered on PROSPERO and performed using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. PubMed, SCOPUS, and Cochrane Central Register of Controlled Trials were searched for Level I-III studies that compared the incidence of ACL injuries on AT versus NG in soccer players. Data recorded included study demographics, sex, competition level, exposure setting (games or practices), turf type, and ACL injury information. Study methodological quality was analyzed using the Methodological Index for Non-Randomized Studies (MINORS) score. Incidence rate ratios (IRRs) were calculated by dividing the incidence of ACL injury on AT over NG, where IRRs < 1 indicate a lower incidence of ACL injuries on AT compared to NG, and IRRs > 1 signify a higher incidence of ACL injuries on AT compared to NG. A Mantel-Haenszel random effects model was used for meta-analyses of IRRs, and forest plots were generated for the pooled IRR for ACL injuries in game and training settings. Additionally, sub-analyses based on athlete sex were conducted for IRRs of ACL injuries in games. A p-value of less than 0.05 was set as significant. Results: Seven articles (four male, two female, one male and female cohort; mean MINORS score 20 + 0.8) were included and analyzed (Figure 1). There were two studies that investigated ACL injuries in a female only cohort, four studies that used a male only cohort, and one study that included both males and females (Table 1). Levels of play included professional (n = 3 studies), college (n = 3 studies), and youth (n = 1 studies). Pooled ACL injury IRRs demonstrated no significant differences in overall ACL injury risk when playing soccer on AT compared to NG (IRR = 0.61 [0.23-1.60], p = 0.31; Figure 2). A significantly increased risk of ACL injury in games played on AT compared to NG was detected for females (IRR = 1.18 [1.05-1.31], p = 0.004) but not for males (IRR = 1.18 [0.97- 1.42], p = 0.09; Figure 3). Subgroup analyses showed no significant differences in injury risk for games (IRR = 1.07 [0.97- 1.18], p = 0.20) or practices (IRR = 0.21 [0.04-1.23], p = 0.09; Figure 2). A total of 3,023 ACL injuries occurred on NG and 526 ACL injuries happened on AT, and the majority of soccer exposures in each study was on NG (range: 50.33% - 85.74%). Conclusions: .This investigation found that females had a significantly higher risk of ACL injury when playing games on AT versus NG, whereas no significant difference was seen in males. No differences were found for the combined male/female population nor soccer games or training sessions played on AT compared to NG. [Figure: see text][Figure: see text][Figure: see text][Table: see text]

PURPOSE This study aimed to assess the associations between serious injury (≥3-month time loss) and level of specialization among high-level female soccer players and to compare the specialization and college commitment ages of female youth soccer players to Division I college and professional soccer athletes. METHODS Youth, college, and professional female soccer players in the United States playing in the top league at each level were recruited to complete an anonymous online survey. The survey collected information about player demographics, soccer specialization and training patterns, history of serious injuries from soccer, and perceptions surrounding soccer specialization. Comparisons between groups were performed using two-sample t-tests, χ2 analyses, and multiple logistic regression models controlling for differences in age. A P value of less than 0.05 was set as significant. RESULTS A total of 1,018 (767 youth, 251 college/professional) athletes completed the survey. Serious injuries affected 23.6% of youth and 51.4% of college/professional athletes. Anterior cruciate ligament tears were more prevalent in college/professional players compared with youth athletes (18.3% vs 4.0%; P < 0.001). Highly specialized youth athletes (66.5%) were more likely to have sustained a serious injury from soccer compared with athletes with low specialization (odds ratio, 2.28 (1.38-3.92); P = 0.008) but not moderate specialization (odds ratio, 1.37 (0.83-2.27); P = 0.43). A higher proportion of youth athletes specialized at a young age (≤10 yr) compared with college/professional players (44.2% vs 25.9%; P < 0.001). CONCLUSIONS High specialization in female youth soccer players is associated with an increased likelihood of sustaining a serious injury. Current youth soccer players are specializing earlier and committing to play college soccer at a younger age compared with when current college and professional players did.

Background Google Trends (GT) is a free tool that provides analysis of search traffic for specified terms entered into the Google search engine. In this study, we evaluate the association between public interest in hand osteoarthritis (OA) as determined by GT search volumes and healthcare usage related to hand OA. Methodology We compiled GT data from 2010 to 2017 for the following group of hand OA-related search terms: “hand osteoarthritis,” “hand arthritis,” “hand swelling,” “hand stiffness,” and “chronic hand pain.” Claims associated with hand OA codes were obtained from an administrative database (14.8 million patients) using International Classification of Diseases codes from 2010 to 2017. We performed trend analysis using univariate linear regression of GT data and hand OA claims. A month-by-month analysis of variation from yearly GT means was conducted for hand OA-related search terms. Results There was increased public interest in hand OA-related search terms from January 2010 to December 2017. Univariate linear regression of GT data for hand OA-related search terms compared with hand OA claims demonstrated a significant positive correlation (p < 0.001, r = 0.707). Peak public interest in hand OA-related search terms was observed in July, May, and June. Conclusions This study demonstrates the ability of GT to track healthcare use related to hand OA. Our data also add to the evidence for monthly variations in public interest related to hand OA. Clinics and surgery centers can employ GT data to anticipate resource utilization by hand OA patients.

Uvular necrosis is a rare postoperative complication that can manifest from endotracheal tube intubation or laryngeal mask airway placement resulting in compression and restriction of blood flow to the uvula. This report describes three patients who underwent outpatient shoulder surgery under general anesthesia and were subsequently diagnosed with uvular necrosis. Their symptoms included persistent sore throat, dysphagia, odynophagia, and foreign body sensation, with swelling and white exudate on the uvular tip. All three patients were treated conservatively and had complete symptom resolution. While symptoms from uvular necrosis typically self-resolve within two weeks, it is important to recognize the condition and risk factors because patients may benefit from reassurance and conservative treatment.

Sexual abuse against women and girls in Malawi is pervasive, and survivors face significant barriers in their quest for justice. One particular barrier—the “corroboration rule”—stands out as a discriminatory and onerous roadblock for women and girls who seek justice as victims of sex crimes. The corroboration rule is a common law rule of evidence and criminal procedure that requires prosecutors trying sex offence cases to have independent evidence in addition to a victim’s testimony, even if that testimony is credible and shows beyond a reasonable doubt that the defendant committed the sex crime. This heightened evidentiary standard for victims of sex crimes is based on the stereotype that women and girls are apt to lie about being raped and that their word alone—no matter how clear, convincing, or credible—should not be enough to put a rapist behind bars. Because of the rule, too many women and girls in Malawi are not treated equally in the criminal justice system, and rarely are those who sexually abuse them brought to justice in court. This fosters a climate of impunity for rapists and sexual abusers. While many countries around the world used to require the corroboration rule in sexual offences, in the modern era, Malawi stands apart from the rest of the world as one of the few countries that still requires its use as a matter of common law. However, with a constitution that guarantees equality for women and girls and equal access to justice under the law, and as a State Party to treaties that guarantee the same, Malawi’s Parliament should abolish the corroboration rule.

Objectives: High cumulative workloads and spikes in player workloads have been associated with an increased risk of injury in soccer and other sports. These studies, however, have all been conducted with data from male soccer players or male athletes in other sports, with few studies investigating female athletes. Using metrics collected from GPS units to monitor cumulative load and distance may be valuable for injury prevention. The purpose of this study was to examine the relationship between injury risk and workload as collected from wearable GPS units in NCAA Division I women’s soccer players. Methods: Lower extremity injury incidence and GPS workload data (player load, total distance, and high-speed distance) of 65 NCAA Division I women’s soccer players were collected over 3 seasons. Accumulated 1-, 2-, 3- and 4-weekly loads and acute: chronic workload ratios (ACWR) were classified into discrete ranges by z-scores. ACWR was calculated using rolling averages and exponentially weighted moving averages (EWMA) models. Binary logistic regression models were used to compare the 7:28 rolling average and EWMA ACWRs between injured and non-injured players for all GPS/accelerometer variables. The prior 1-, 2-, 3-, and 4-weekly accumulated loads for all GPS/accelerometer variables were compared between the injured and uninjured cohorts using two-sample t-tests with an alpha level of 0.05 set as significant. Results: There were a total of 53 lower extremity injuries that resulted in lost time recorded (5.76/1000 hours ‘on-field’ exposure time; 34 non-contact and 19 contact injuries). The prior 2-week (7,242 vs 6,613; p=0.02), 3-week (10,533 vs 9,718; p=0.02), and 4-week (13,819 vs 12,892; p=0.04) accumulated player loads and 2-week (62.40 vs 57.25 km; p=0.04), 3-week (90.97 vs 84.10 km; p=0.03), and 4-week (119.31 vs 111.38 km; p=0.05) accumulated total distances were significantly higher for injured players compared to non-injured players during the same timeframes. There were no significant differences in player load, total distance, or high-speed distance ACWR between injured and non-injured players for both the rolling averages and EWMA calculations. Conclusions: Higher accumulated player load and total distance, but not ACWR, are associated with injury in women’s soccer players.

Background:The teres minor is a critical component of the rotator cuff and serves as one of the few external rotators of the humerus. Information is lacking regarding the effect of teres minor atrophy in isolation and in the setting of concomitant full-thickness rotator cuff tears on outcomes in patients undergoing rotator cuff surgery.Purpose:To investigate the effect of preoperative teres minor fatty infiltration on postoperative clinical outcomes in patients with and without full-thickness rotator cuff pathology.Study Design:Cohort study; Level of evidence, 3.Methods:A retrospective review of patients undergoing primary arthroscopic shoulder surgery between 2014 and 2016 was performed. Preoperative magnetic resonance imaging was used to determine fatty infiltration for each rotator cuff muscle using the modified Goutallier classification. American Shoulder and Elbow Surgeons (ASES) as well as the shortened version of Disabilities of the Arm, Shoulder and Hand (QuickDASH) scores were obtained preoperatively and during follow-up. Exclusion criteria included prior surgery on the ipsilateral shoulder or a diagnosis of inflammatory arthropathy. For analysis, patients were dichotomized to grade 0 or grade 1-4 atrophy of the teres minor as well as to full-thickness or partial-thickness rotator cuff pathology.Results:A total of 36 of 47 (76.6%) patients (mean age, 63 years; range, 45-76 years) were available for postoperative follow-up at a mean of 40 months (range, 30-48 months). Postoperative ASES score was significantly higher and QuickDASH score was significantly lower among all patients in the grade 0 group compared with the grade 1-4 group. Postoperative ASES and QuickDASH scores were not significantly different in patients with partial-thickness rotator cuff tears at any time point. However, the postoperative ASES score was significantly higher and QuickDASH score was significantly lower in the grade 0 versus grade 1-4 group for patients with full-thickness rotator cuff pathology.Conclusion:Preoperative teres minor atrophy in patients undergoing surgery for rotator cuff pathology may impair postoperative clinical outcomes, especially in patients with full-thickness tears.

Background: Progenitor cells serve as a promising source of regenerative potential in a variety of tissue types yet remain underutilized in tendinopathy. Tendon-derived progenitor cells (TDPCs) have previously been isolated from hamstring tendon but only as part of a concomitant medical procedure. Determining the presence of TDPCs in patellar tendon may facilitate clinical utilization of these cells because of the relative accessibility of this location for tissue harvest. Purpose: To characterize TDPCs in human patellar tendon samples. Study Design: Descriptive laboratory study. Methods: Human patellar tendon samples were obtained during elective knee surgery. TDPCs were isolated and seeded at an optimal low cell density and subcultured to confluence for up to 2 passages. Flow cytometry was used to analyze for the expression of CD90+, CD105+, CD44+, and CD31–, CD34–, and CD45– markers. The multilineage differentiation potential of TDPCs was tested in vitro via adipogenic, osteogenic, and chondrogenic culture with subsequent cytochemical staining for Oil Red O, Alizarin Red, and Alcian Blue, respectively. Enzyme-linked immunosorbent assay was used to quantify the amount of adiponectin, alkaline phosphatase, and SRY-box transcription factor 9 secreted into cell culture supernatant for further confirmation of lineage differentiation. Results were analyzed statistically using the 2-tailed Student t test. Results: TDPCs demonstrated near-uniform expression of CD90, CD105, and CD44 with minimal expression of CD34, CD31, and CD45. Adipogenic, osteogenic, and chondrogenic differentiation of TDPCs was confirmed using qualitative analysis. The expression of adiponectin, alkaline phosphatase, and SRY-box transcription factor 9 were significantly increased in differentiated cells versus undifferentiated TDPCs ( P < .05). Conclusion: TDPCs can be successfully isolated from human patellar tendon samples, and they exhibit characteristics of multipotent progenitor cells. Clinical Relevance: These data demonstrate the promise of patellar tendon tissue as a source of progenitor cells for use in biologic therapies for the treatment of tendinopathy.

The presence of strategic customers may force an already financially distressed firm into a death spiral: sensing the firm’s financial difficulty, customers may wait strategically for deep discounts in liquidation sales. In turn, such waiting lowers the firm’s profitability and increases the firm’s bankruptcy risk. Using a two-period model to capture these dynamics, this paper identifies customers' strategic waiting behavior as a source of a firm’s cost of financial distress. We also find that customers' anticipation of bankruptcy can be self-fulfilling: when customers anticipate a high bankruptcy probability, they prefer to delay their purchases, making the firm more likely to go bankrupt than when customers anticipate a low probability of bankruptcy. Such behavior has important operational and financial implications. First, the firm acts more conservatively when facing either more severe financial distress or a large share of strategic customers. As its financial situation deteriorates, the firm lowers inventory alone when financial distress is mild or only a small share of customers are strategic and lowers both inventory and price in the presence of severe financial distress and a large fraction of strategic customers. Under optimal price and inventory decisions, strategic waiting accounts for a large part of the firm’s total cost of financial distress, although a larger proportion of strategic customers may result in a lower probability of bankruptcy. In addition to inventory reduction and (immediate) price discount, we find that a deferred discount, in the form of rebates and/or store credits for future purchases, can act as an effective mechanism to mitigate strategic waiting. As a contingent price reduction, deferred discounts align the interests of customers and the firm and are most effective when the fraction of strategic customers is high and the firm’s financial distress is at a medium level.

Alzheimer’s disease (AD) is a neurodegenerative disorder affecting 35 million people worldwide. A common strategy to improve the well-being of AD patients consists on the inhibition of acetylcholinesterase with the concomitant increase of the neurotransmitter acetylcholine at cholinergic synapses. Two series of unreported N-benzylpiperidines 5(a–h) and thiazolopyrimidines 9(a–q) molecules were synthesized and evaluated in vitro for their acetylcholinesterase (AChE) inhibitory activities. Among the newly synthesized compounds, 5h, 9h, 9j, and 9p displayed higher AChE enzyme inhibitory activities than the standard drug, galantamine, with IC50 values of 0.83, 0.98, and 0.73 μM, respectively. Cytotoxicity studies of 5h, 9h, 9j, 9n and 9p on human neuroblastoma cells SH-SY5Y, showed no toxicity up to 40 μM concentration. Molecular docking simulations of the active compounds 5h and 9p disclosed the crucial role of π-π-stacking in their binding interaction to the active site AChE enzyme. The presented compounds have potential as AChE inhibitors and potential AD drugs.

Background: Active patients with musculoskeletal pain are not immune to psychological or psychiatric disease. Observations suggest that patients undergoing hip arthroscopic surgery may have an increased prevalence of comorbid psychiatric conditions. Hypothesis: Patients undergoing hip arthroscopic surgery have an increased prevalence of concomitant psychiatric diagnoses compared with the general population as well as those undergoing anterior cruciate ligament (ACL) reconstruction. Study Design: Case-control study; Level of evidence, 3. Methods: A retrospective review of a medical claims database spanning from 2007 to 2016 was utilized to identify patients with a Current Procedural Terminology (CPT) code indicating that they had undergone hip arthroscopic surgery. This group was then dichotomized to those with or without an International Classification of Diseases, 9th Revision (ICD-9) and 10th Revision (ICD-10) diagnosis code indicating a psychological or psychiatric condition at any time before hip arthroscopic surgery or up to 2 years after hip arthrscopic surgery. As a control, ICD-9 and ICD-10 diagnosis codes for psychological or psychiatric conditions were determined in patients without a CPT code for hip arthroscopic surgery (general population) as well as for 2 surgical groups: those undergoing ACL reconstruction and those undergoing shoulder stabilization surgery. Prevalence was determined in all groups and compared using chi-square analysis. Results: There were 22,676,069 patients in the database, with 2428 undergoing hip arthroscopic surgery. Those undergoing hip arthroscopic surgery had a 3-fold increased prevalence of concomitant psychiatric diagnoses compared with the general population (52% vs 17%, respectively; P < .0001). There was a significant difference in the prevalence of psychiatric diagnoses in the hip arthroscopic surgery group between male and female patients (46% vs 56%, respectively; P = .0061), with depression and anxiety being the 2 most common comorbid conditions. Those undergoing hip arthroscopic surgery also had a significantly increased prevalence of concomitant psychiatric diagnoses versus those undergoing ACL reconstruction (52% vs 28%, respectively; P < .0001) as well as those undergoing shoulder stabilization surgery (52% vs 42%, respectively; P < .0001). Conclusion: Patients undergoing hip arthroscopic surgery had an increased prevalence of comorbid psychiatric conditions compared with the general population as well as those undergoing ACL reconstruction or shoulder stabilization surgery. Depression and anxiety were the most prevalent concomitant psychiatric diagnoses.

Wound dressing has remained challenging for some life-threatening wounds such as burning. Researchers have been engaged in looking for better solutions. This review paper depicted the ideal wound dressing based on the mechanism of human skins, compared traditional wound dressing methods to modern methods, and reviewed the use of polymers and biopolymers as advanced materials for wound dressing.

Retailers face significant pressure to improve revenue, margins and market share by applying price optimisation models. These are mathematical models that calculate how demand varies at different price levels, then combine that data with information on costs and inventory levels to recommend prices that will improve revenue and profits. These models have been around for a while-so what is different now? We have identified three important changes: (1) Data: availability of internal and external real-time data such as traffic to a website, consumers making buy/no buy decisions and competitor pricing strategies; (2) Analytics: advances in machine learning and ease of access (R, Python) have enabled the development of systems that learn on the fly about consumer behaviour and preferences and generate effective estimates of demand-price relationships; and (3) Automation: increase in computing speed enables real-time optimisation of prices of hundreds of competing products sold by the same retailer. We take advantage of these new opportunities by showing how they were applied at Boston-based flash sales retailer Rue La La, online market maker Groupon, and the largest online retailer in Latin America, B2W Digital (B2W). While all these examples are of on-line businesses which have readily available data and can change prices dynamically, we have also implemented similar methods for brick-and-mortar retailed in applications such as promotional pricing, new product introduction, and assortment optimisation with similar business impacts. Thus, beyond applications to price optimisations, these new trends enable companies to revolutionise their business from procurement to supply chain all the way to revenue management. Keywords: analytics, machine learning, price theory, online retail, forecasting

Gugulipid (GL), an extract of Commiphora mukul, has been safely used for thousands of years in the Indian Ayurveda medicine practice for the treatment of different ailments and has been used recently in many clinical trials that focused on its cholesterol-lowering effect. GL has recently been paid great attention for its cancer chemopreventive and chemotherapeutic potential. Z- and E-Guggulsterone have been identified as the major active components of GL. Studies have shown that GL as well as Guggulsterones can inhibit cancer growth in vitro and in vivo and lead to prevention of cancer initiation, promotion and progression. Although the action mechanisms of GL are not completely understood, GL has been revealed as a multitargeted cancer chemopreventive and chemotherapeutic agent. The increased understanding of the anti-cancer activity of GL and its molecular targets would allow us to improve its efficacies in different types of human cancers by single and/or combination strategies.