Search

Emerging Internet of Things (IoT) devices necessitate system-on-chips (SoCs) that can scale from ultralow power always-on (AON) operation, all the way up to less frequent high-performance tasks at high energy efficiency. Specialized accelerators are essential to help meet these needs at both ends of the scale, but maintaining workload flexibility remains an important goal. This article presents a 25-mm² SoC in 16-nm FinFET technology which demonstrates targeted, flexible acceleration of key compute-intensive kernels spanning machine learning (ML), DSP, and cryptography. The SMIV SoC includes a dedicated AON sub-system, a dual-core Arm Cortex-A53 CPU cluster, an SoC-attached embedded field-programmable gate array (eFPGA) array, and a quad-core cache-coherent accelerator (CCA) cluster. Measurement results demonstrate: 1) 1236x power envelope, from 1.1 mW (only AON cluster), up to 1.36 W (whole SoC at maximum throughput); 2) 5.5-28.9x energy efficiency gain from offloading compute kernels from A53 to eFPGA; 3) 2.94x latency improvement using coherent memory access (CCA cluster); and 4) 55x MobileNetV1 energy per inference improvement on CCA compared to the CPU baseline. The overall flexibility-efficiency range on SMIV spans measured energy efficiencies of 1x (dual-core A53), 3.1x (A53 with SIMD), 16.5x (eFPGA), 54.9x (CCA), and 256x (AON) at a peak efficiency of 4.8 TOPS/W.

Virtual care in cancer care existed in a limited fashion globally before the COVID-19 pandemic, mostly driven by geographic constraints. The pandemic has required dramatic shifts in health care delivery, including cancer care. We conducted a systematic review of comparative studies evaluating virtual versus in-person care in patients with cancer. Embase, APA PsycInfo, Ovid MEDLINE, and the Cochrane Library were searched for literature from January 2015 to 6 August 2020. We adhered to PRISMA guidelines and used the modified GRADE approach to evaluate the data. We included 34 full-text publications of 10 randomized controlled trials, 13 non-randomized comparative studies, and 5 ongoing randomized controlled trials. Evidence was divided into studies that provide psychosocial or genetic counselling and those that provide or assess medical and supportive care. The limited data in this review support that in the general field of psychological counselling, virtual or remote counselling can be equivalent to in-person counselling. In the area of genetic counselling, telephone counselling was more convenient and noninferior to usual care for all outcomes (knowledge, decision conflict, cancer distress, perceived stress, genetic counseling satisfaction). There are few data for clinical outcomes and supportive care. Future research should assess the role of virtual care in these areas. Protocol registration: PROSPERO CRD42020202871.

Solid organ transplantation (SOT) recipients have complex medical and surgical risk factors; however, the outcomes of these patients undergoing surgical fixation of hip fractures are unknown. This study sought to evaluate SOT patients’ outcomes and survivorship after intertrochanteric (IT) fracture fixation. A retrospective review identified 12 SOT patients who underwent cephalomedullary (CMN) nail fixation for IT fractures and were matched (1:2) to a cohort of 24 non-SOT IT fracture patients. Perioperative results and complications, mortality/patient survivorship, and clinical outcomes were compared between the cohorts. The time from presentation to surgical fixation was within 48 h of presentation for the non-SOT patients, while only 75% of SOT patients underwent surgery within 48 h of presentation (p = 0.034). The 90-day readmission rate for SOT patients was 25% versus 13% in the non-SOT group (p = 0.38). Similarly, the SOT cohort experienced a higher rate of major medical complication (25% vs. 13%, p = 0.38). There were two (16%) reoperations in the SOT group and three (13%) in the non-SOT matched group (p = 0.99). Respectively, the 90-day and 1-year estimated patient survivorship was similar between the two cohorts: SOT patients with 92% (95% CI 54–99%) and 73% (95% CI 24–93%) versus 86% (95% CI 62–95%) and 72% (95% CI 47–86%, HR 0.92, 95% CI 0.18–4.62, p = 0.92) in non-SOT patients. SOT patients who underwent CMN fixation for IT fractures required more time from hospital presentation to surgical management than non-SOT patients. Although not statistically significant, SOT patients demonstrated more acute complications and readmissions, but similar mortality compared to those without transplant.

As a specialty, radiology has spent much of the last two decades implementing information systems that improve departmental efficiency and the ordering provider's access to information. While our patients have realized benefits such as improved access to care and reduced turnaround times, there has been little focus on using these information systems to improve patient engagement. In the last decade, society has shifted. Now, consumers in every industry expect to be able to use technology to help them accomplish different tasks from scheduling to communicating. Medicine, in general, has been slow to respond to the concept of the patient as a consumer. In this manuscript we describe some of the informatics efforts we have employed in our department to improve patient engagement. We present these initiatives, corresponding to each aspect of the radiology value stream, from the patient's point of view.

The current trend for domain-specific architectures has led to renewed interest in research test chips to demonstrate new specialized hardware. Tapeouts also offer huge pedagogical value garnered from real hands-on exposure to the whole system stack. However, success with tapeouts requires hard-earned experience, and the design process is time consuming and fraught with challenges. Therefore, custom chips have remained the preserve of a small number of research groups, typically focused on circuit design research. This article describes the CHIPKIT framework: a reusable SoC subsystem which provides basic IO, an on-chip programmable host, off-chip hosting, memory, and peripherals. This subsystem can be readily extended with new IP blocks to generate custom test chips. Central to CHIPKIT is an agile RTL development flow, including a code generation tool called VGEN. Finally, we discuss best practices for full-chip validation across the entire design cycle.

Background Ehlers-Danlos syndromes (EDSs) are connective-tissue disorders resulting in joint laxity. Soft-tissue stability is a concern in these patients when they undergo total hip arthroplasty (THA). Our purpose was to compare THAs in the population with EDS with a matched control undergoing THA for osteoarthritis. Methods Thirteen patients with EDS underwent THA from 1997 to 2017. Matching was 1:3 with a control group of patients who underwent THA for osteoarthritis. Matching was based on the gender, age, and length of follow-up. Results We found no difference in demographics or postoperative Harris Hip Scores between the cohorts (P > .05). Two patients (15.4%) with EDS and 2 patients (5.1%) in the control group suffered a dislocation. We found no difference in the reoperation or revision rate between the groups (P = .28). Conclusions Patients with EDS have a significant improvement in postoperative Harris Hip Scores after THA. These patients also have a high dislocation rate after surgery, and alternative approaches and technologies such as dual-mobility components should be considered to reduce the rate of dislocation in this population.

Hallux valgus deformity is a progressive forefoot deformity consisting of a prominence derived from a medially deviated first metatarsal and laterally displaced great toe, with or without pronation. Although there is agreement that the deformity is likely caused by multifactorial intrinsic and extrinsic factors, the best method of operative management is debated despite the creation of basic algorithms. Our understanding of the deformity and the development of newer techniques is continuously evolving. Here, we review the general orthopaedic principles of operative decision-making and management of hallux valgus deformity.

Previous versions of the guideline from the Program in Evidence-Based Care (pebc) at Ontario Health (Cancer Care Ontario) recommended that the use of high-dose interferon alfa 2b therapy be discussed and offered to patients with resected cutaneous melanoma with a high risk of recurrence. Subsequently, several clinical trials in patients with resected or metastatic melanoma found that immune checkpoint inhibitors and targeted therapies have a benefit greater than that with interferon. It was therefore considered timely for an update to the guideline about adjuvant systemic therapy in melanoma. The present guideline was developed by the pebc and the Melanoma Disease Site Group (dsg). Based on a systematic review from a literature search conducted using medline, embase, and the Evidence Based Medicine Reviews databases for the period 1996 to 28 May 2019, the Working Group drafted recommendations. The systematic review and recommendations were then circulated to the Melanoma dsg and the pebc Report Approval Panel for internal review, the revised document underwent external review. For patients with completely resected cutaneous or mucosal melanoma with a high risk of recurrence, the recommended adjuvant therapies are nivolumab, pembrolizumab, or dabrafenib&ndash, trametinib for patients with BRAF V600E or V600K mutations, nivolumab or pembrolizumab are recommend for patients with BRAF wild-type disease. Use of ipilimumab is not recommended. Molecular testing should be conducted to help guide treatment decisions. Interferon alfa, chemotherapy regimens, vaccines, levamisole, bevacizumab, bacillus Calmette&ndash, Gu&eacute, rin, and isolated limb perfusion are not recommended for adjuvant treatment of cutaneous melanoma except as part of a clinical trial.

Background: The Internet is often the first resource used by applicants to evaluate fellowship programs. However, information on these websites can be often incomplete, inaccessible, and/or inaccurate. The primary objective of this study was to examine key factors that orthopedic foot and ankle fellowship applicants use to rank programs. The secondary objective was to assess both the accessibility and availability of the information on orthopedic foot and ankle fellowship program websites. Methods: A Qualtrics survey was distributed via e-mail to those who matched into an orthopedic foot and ankle fellowship position from years 2008-2020. A comprehensive list of orthopedic foot and ankle fellowship programs was created. Program websites were evaluated for accessibility as well as the quality of recruitment and educational content. Results: There were a total of 114 survey responses out of 644 invites (17.7%). The most important factors for establishing a rank list were operative experience, current faculty, and program reputation. Eighty-five percent (41/48) of orthopedic foot and ankle fellowship websites were directly accessible using Google. On average, accessible orthopedic foot and ankle fellowship websites contained only 57% (11.5/20) of the content deemed desirable. Conclusion: Orthopedic foot and ankle websites are widely accessible and have higher recruitment and educational quality content scores compared with previously published data. The most important factors for establishing a rank list are consistent with previous literature. Those who ranked operative experience as one of the most important factors when establishing a rank list did not complete more operative cases than those who did not. Level of Evidence: Level IV.

In this work, we present SM6, an SoC architecture for real-time denoised speech and NLP pipelines, featuring (1) MSSE: an unsupervised probabilistic sound source separation accelerator, (2) FlexNLP: a programmable inference accelerator for attention-based seq2seq DNNs using adaptive floating-point datatypes for wide dynamic range computations, (3) a dual-core Arm Cortex A53 CPU cluster, which provides on-demand SIMD FFT processing, and operating system support. In adverse acoustic conditions, MSSE allows FlexNLP to store up to 6x smaller ASR models obviating the very inefficient strategy of scaling up the DNN model to achieve noise robustness. MSSE and FlexNLP produce efficiency ranges of 4.33-17.6 Gsamples/s/W and 2.6-7.8TFLOPs/W, respectively, with per-frame end-to-end latencies of 15-45ms.

Background:Dorsal pain from osteoarthritic midfoot joints is thought to be relayed by branches of the medial and lateral plantar, sural, saphenous, and deep peroneal nerves (DPN). However, there is no consensus on the actual number or pathways of the nervous branches for midfoot joint capsular innervation. This study examined the DPN’s terminal branches at the midfoot joint capsules through anatomic dissection and confirmation of their significance in a clinical case series of patients with midfoot pain relief after DPN block.Methods:Eleven cadaveric lower leg specimens, 6 left and 5 right, were dissected using operative loupe magnification. We preserved the terminal branches and recorded their paths and branching patterns. Joint capsular innervations were individually noted. To confirm our hypothesis of significant dorsal midfoot joint capsular innervation by the DPN, we also performed an institutional review board–approved retrospective chart review of 37 patients with painful dorsal midfoot osteoarthritis who underwent diagnostic local anesthetic injection block of the DPN. The percentage of temporary pain relief after the injection was recorded.Results:Terminal innervation of the DPN branches showed distribution of the second and third tarsometatarsal joints in all specimens. Inconsistent innervation of the naviculocuneiform (9/11), fourth (7/11), first (6/11), and fifth (4/11) tarsometatarsal and calcaneocuboid joints (1/11) were observed. The retrospective review of pain relief in patients with dorsal midfoot pain due to arthritis after diagnostic injection demonstrated a mean of 92.1% improvement.Conclusion:Innervation of the dorsal midfoot joint capsule appears to follow a consistent distribution across 3 joints: second and third tarsometatarsal joints and the naviculocuneiform joint. Acute relief of dorsal midfoot arthritic pain after diagnostic injection suggests that dorsal midfoot nociceptive pain is at least partly transmitted by the DPN.Level of Evidence:Level IV, case series.

Monolayers of transition-metal dichalcogenides (TMDs) are promising components for flexible optoelectronic devices because of their direct band gap and atomically thin nature. The photoluminescence (PL) from these materials is often strongly suppressed by nonradiative recombination mediated by midgap defect states. Here, we demonstrate up to a 200-fold increase in PL intensity from monolayer MoS2 synthesized by chemical vapor deposition (CVD) by controlled exposure to laser light in the ambient. This spatially resolved passivation treatment is stable in air and vacuum. Regions unexposed to laser light remain dark in fluorescence despite continuous impingement of ambient gas molecules. A wavelength-dependent study confirms that PL brightening is concomitant with exciton generation in the MoS2; laser light below the optical band gap fails to produce any enhancement in the PL. We highlight the photosensitive nature of the process by successfully brightening with a low-power broadband white light source. We decouple changes in absorption from defect passivation by examining the degree of circularly polarized PL. This measurement, which is independent of exciton generation, confirms that laser brightening reduces the rate of nonradiative recombination in the MoS2. A series of gas exposure studies demonstrate a clear correlation between PL brightening and the presence of water. We propose that H2O molecules passivate sulfur vacancies in the CVD-grown MoS2 but require photogenerated excitons to overcome a large adsorption barrier. This work represents an important step in understanding the passivation of CVD-synthesized TMDs and demonstrates the interplay between adsorption and exciton generation.

Category: Bunion; Midfoot/Forefoot; Other Introduction/Purpose: Previous studies have demonstrated success in using autogenous bone graft for arthrodesis in patients with previously failed surgeries of the hallux. These patients have several causes for pain and dysfunction preoperatively, including shortened first ray, nonunions, and poor hallux alignment. In this study, a consecutive series of 36 patients (38 procedures) were treated with a patellar wedge interposition structural allograft to salvage bone loss from great toe arthrodesis malunion, painful joint replacement, failed osteotomy, or infection of the great toe metatarsophalangeal (MP) joint with shortening of the first ray. The goals of the surgery were to restore length to the first ray and provide a stable MP joint fusion to relieve pain. Methods: The 38 treated toes were followed for at least one year and were evaluated for preoperative and postoperative American Orthopaedic Foot & Ankle Society (AOFAS) MP scores, subjective patient outcome scores, and clinically successful fusion of the hallux. Results: At a minimum one-year follow-up, all but two feet healed with a solid fusion, and all patients reported good or excellent outcomes. AOFAS MP scores averaged 43.5 preoperatively and 77.2 postoperatively. Three patients with infection as cause for nonunion of the initial procedure were treated with staged procedures, including the use of a temporary antibiotic spacer and mini external fixator; all three healed without recurrent infection. One patient had a fracture of her allograft following her interposition arthrodesis, but fused successfully after a second interposition arthrodesis surgery. Two patients developed a nonunion of the revision arthrodesis. Conclusion: In conclusion, the use of an interposition patellar wedge allograft can restore length to the first ray and provide successful salvage of arthrodesis nonunions and bone loss from failed hemi and total joint implants of the great toe MP joint. [Table: see text]

Automatic speech recognition (ASR) using deep learning is essential for user interfaces on IoT devices. However, previously published ASR chips [4 –7] do not consider realistic operating conditions, which are typically noisy and may include more than one speaker. Furthermore, several of these works have implemented only small-vocabulary tasks, such as keyword-spotting (KWS), where context-blind deep neural network (DNN) algorithms are adequate. However, for large-vocabulary tasks (e.g., $\gt100\mathrm{k}$ words), the more complex bidirectional RNNs with an attention mechanism [1] provide context learning in long sequences, which improve ASR accuracy by up to 62% on the 200kwords LibriSpeech dataset, compared to a simpler unidirectional RNN (Fig. 9.8.1). Attention-based networks emphasize the most relevant parts of the source sequence during each decoding time step. In doing so, the encoder sequence is treated as a soft-addressable memory whose positions are weighted based on the state of the decoder RNN. Bidirectional RNNs learn past and future temporal information by concatenating forward and backward time steps.

Objectives: To determine the location and stage of the tibial nailing procedure where infrapatellar saphenous nerve (IPSN) injury may occur. Methods: Fourteen fresh-frozen right cadaveric knees underwent tibial nailing. Six knees underwent a suprapatellar approach and 8 a medial parapatellar approach. Two proximal medial-to-lateral screws were placed using the aiming guide. The incisions were then closed. After the procedure, medial retinacular and saphenous nerves were dissected under surgical 2.5× loupe magnification from a proximal to distal direction. The branch of the IPSN closest to the locking screws was measured, as was the distance between the IPSN branch and the inferior pole of the patella. Results: Twelve of 14 cadavers had prominent IPSN (main branch from the saphenous proper) with an average of 2.5 sub-branches. The mean (SD) distance from the main branch of the IPSN to the inferior pole of the patella was 40.9 (24.4) mm. Four medial retinacular nerve branches, branching from the femoral nerve and not IPSN, were identified proximal to the patella during the medial parapatellar approach. All were cut after the medial parapatellar arthrotomy. The mean (SD) distance from the IPSN to the nearest locking screw was 10.2 (14.1) mm. Seven of 14 had IPSN injuries, and one had hamstring injury. Two direct screw entrapments occurred, whereas two IPSNs were lacerated by the incision. Suture closure entrapped three nerve branches, and one specimen had injured fibers of the hamstring tendinous insertion. Conclusions: Injury to the IPSN can occur at different locations and stages of tibial nailing, including approach, proximal locking screw insertion, and closure.

Category: Bunion; Midfoot/Forefoot Introduction/Purpose: The proximal opening wedge metatarsal osteotomy (PMO) of the first metatarsal is a common procedure for the surgical treatment of moderate to severe hallux valgus. Although with a long track record of success, limited work has been dedicated to this procedures effect on the first tarsometatarsal (TMT-1) joint. The purpose of this study is to evaluate the changes in TMT-1 joint contact stress in the diseased and corrected state following an opening wedge osteotomy of the proximal metatarsal. In addition, the effect of a distal soft tissue release (DSTR) was evaluated as it related to both radiographic correction and TMT-1 joint contact stress. Methods: Seven fresh-frozen cadaveric below knee specimens (mean age: 69yrs) with hallux valgus deformities (mean HVA: 31.7+-12.0degs) were obtained for the study. The specimen was loaded up to 400N on an MTS servo hydraulic load frame with the tibia at 90-degree to the neutrally position foot. Joint contact characteristics at TMT-1 joint were measured with a Tekscan pressure sensor (Model6900, 1100psi). A standard proximal metatarsal osteotomy was performed. Various sized metal wedges (3, 5, 7 mm) with locking plates and screws were inserted in the osteotomy for correction. Following initial tests, a complete distal soft tissue release (DSTR) was performed and the specimens were retested. Additionally, dorsoplantar weight bearing (400N) radiograph was obtained for each condition to measure intermetatarsal (IMA) and hallux valgus (HVA) angles. The contact force, area, and peak contact stress were compared among groups using ANOVA and post-hoc multiple comparisons over the untreated (Dunnett test, pResults: The mean HVA decreased with wedge size and DSTR, reached to significant level with 7mm+DSTR (24.1 degs). The mean contact force was 39.7+-32.6 N for untreated specimens. This increased sequentially with opening wedge size and reached statistical significance 7mm opening-wedge (119.6+-53.8 N, p=0.03) and 7mm-wedge+DSTR (116.7+-58.3 N, p=0.04). The peak contact stress followed a similar trend (Figure 1). The mean peak contact stress was 2.3+-1.5 MPa for the untreated specimens and increased incrementally with wedge size to 5.3+-2.6 MPa for 7mm-wedge only (p=0.03) and 5.2+-2.1 MPa for 7mm- wedge+DSTR (p=0.04). Contact area increased with corrections, but none reached significance. Conclusion: The results from this study demonstrate that with sequentially increasing opening wedge size, loading properties through the TMT-1 joint increase. Prior work has demonstrated that joint stresses of over 4.7 MPa can be chondrotoxic, a value which was surpassed with our peak contact stress with the 7mm wedge. This has significant implications for the long-term health of the TMT-1 joint following PMO, potentially predisposing patients to arthritic joint changes. The optimal degree of correction with PMO to limit chondrotoxicity is not known at this time, and is a direction for future work.

Introduction The accurate diagnosis of acute septic arthritis is essential to initiating appropriate treatment and minimizing potential cartilage damage. A synovial fluid cell count of 50,000 cells/mm3 has been used as a diagnostic cutoff for acute septic arthritis, although data supporting this is lacking. The purpose of this study was to assess the efficacy of synovial cell counts to predict septic arthritis in patients with symptomatic native joints. Methods A retrospective review was performed of patients who were evaluated for septic arthritis at a single institution with the use of synovial fluid analysis and adjunctive lab tests. Exclusion criteria included history of a total joint arthroplasty of the affected joint or immunocompromised state. A true infection was considered on the basis of positive or negative synovial aspirate cultures. We evaluated the synovial cell count, synovial polymorphonuclear cell percentile (% neutrophils), serum white blood cell (WBC), erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP) in order to determine their association and predictive power in a true infection. Results Of the 65 patients included in the study, 40 (61.5%) had a positive culture for septic arthritis and 25 (38.5%) had negative cultures. Patients with positive cultures had a larger median % neutrophils than patients with negative cultures (median: 93 vs. median: 86, P=0.041). They also tended to have higher serum CRP levels compared to negative culture patients (median: 142.30 vs. 34.20, P=0.051). No outcomes were independently highly effective in discriminating between patient groups (area under the curve (AUC) ≤ 0.67). There was no significant difference between the synovial cell counts in patients with culture positive septic arthritis and patients with negative cultures (median: 32435 vs 35385, P = 0.94). Conclusion Patients with culture proven septic arthritis had larger % neutrophils. However, there were no other statistically significant differences between patient groups regarding ESR, CRP, WBC, or cell count aspiration at the time of diagnosis. No synovial cell count level was highly effective in discriminating patients with a positive culture for septic arthritis from patients with negative cultures.

Background Range of motion (ROM) is a critical component of a physician’s evaluation for many consultations. The purpose of this study was to evaluate if teleconference goniometry could be as accurate as clinical goniometry. Methods Forty-eight volunteers participated in the study. There was a sample size of 52 elbows. Each measurement was recorded consecutively in person, through teleconference, and still-shot photography by two researchers trained in goniometry. Measurements of maximum elbow flexion and extension were taken and recorded. Results Teleconference goniometry had a high agreement with clinical goniometry (Pearson coefficient: flexion: 0.93, Extension: 0.87). Limits of agreement found from the Bland-Altman test were 7⁰ and -3⁰ for flexion and 10.4⁰ and -7.4⁰ for extension. A t-test revealed a P-value of less than 0.001 between teleconference and clinical measurements, proving the data are significant. Conclusions ROM measurements through a teleconferencing medium are comparable to clinical ROM measurements. This would allow for interactive elbow ROM assessment with the orthopedist without having to incorporate travel time and expenses.

Introduction: Previous studies have recommended synovial fluid cell count thresholds of 50,000 cells/mm−3 to diagnose septic arthritis; however, data to support this are limited. It is also unknown if this value is valid in immunosuppressed patients. Methods: We retrospectively reviewed 33 immunosuppressed patients treated at our institution from 2008 to 2018. We compared culture-positive patients with culture-negative patients. Results: We found no statistically significant differences in synovial fluid cell count, percent synovial fluid neutrophils, erythrocyte sedimentation rate, or C-reactive protein between the groups (all P = 0.081). The median synovial fluid cell count in the culture-positive cohort was 29,000 cells/mm−3, with only 31.2% having >50,000 cells/mm−3. Conclusion: Traditional synovial fluid cell thresholds are not a reliable method of diagnosing septic arthritis in immunosuppressed patients.

Cutaneous melanoma is typically treated with wide local excision and, when appropriate, a sentinel node biopsy. Many patients are cured with this approach but for patients who have cancers with high risk features there is a significant risk of local and distant relapse and death. Interferon-based adjuvant therapy was recommended in the past but had modest results with significant toxicity. Recently, new therapies (immune checkpoint inhibitors and targeted therapies) have been found to be effective in the treatment of patients with metastatic melanoma and many of these therapies have been evaluated and found to be effective in the adjuvant treatment of high risk patients with melanoma. This systematic review of adjuvant therapies for cutaneous and mucosal melanoma was conducted for Ontario Health (Cancer Care Ontario) as the basis of a clinical practice guideline to address the question of whether patients with completely resected melanoma should be considered for adjuvant systemic therapy and which adjuvant therapy should be used.

Background: While total knee arthroplasty (TKA) is a reliable treatment for advanced knee arthritis, up to 19% of patients after TKA remain dissatisfied, especially with residual pain. A less known source of medial knee pain following TKA is infrapatellar saphenous neuroma. Ultrasound-guided local treatment with hydrodissection and corticosteroid injection is an effective short-term solution. Our primary aim was to evaluate the durability of local treatment by comparing numeric pain scores for medial knee pain after TKA at pretreatment, one month following treatment, and midterm follow-up. A secondary aim was to identify associations of patient characteristics with degree of change in numeric pain score. Methods: Retrospective chart review was performed to identify patients who had symptomatic infrapatellar saphenous neuroma following TKA and were treated with ultrasound-guided local treatment by hydrodissection and corticosteroid injection between January 1, 2012, and January 1, 2016. Those with follow-up less than three years were excluded. Patients who were unable to return for midterm follow-up were called. Numeric pain scores for the medial knee were recorded. Patient demographics, medical history, revision TKA status, number of prior knee surgeries, narcotic use, psychiatric disorders, and current tobacco use were also collected. Results: Of 32 identified patients, 29 (7 men, 22 women, median age 65.9 years) elected to participate in this study with a mean (SD) follow-up of 4.6 (0.8) years. The median (range) pretreatment pain score was 9 (5-10). After local treatment, the median (range) numeric pain score was significantly lower at both one-month and midterm follow-up (5; P

Entrapment of the extensor indicis proprius (EIP) after open reduction and internal fixation (ORIF) of the distal ulna with a plate and screw construct is rare. By literature review, we found evidence of such complication associated with distal radius fracture, but no past reports relating to the distal ulna. ORIF of the distal ulna is a common procedure for both fracture treatment and deformity correction. Due to the EIP muscle originating primarily from the dorsoradial surface of the distal ulna and the adjacent interosseous membrane, the muscle may be damaged or compressed by a fixation plate during ORIF, resulting in entrapment. We present two case reports of this rare complication, describing the method of clinical diagnosis, surgical treatment, and outcome. Our accompanying cadaver dissection provides an explanation for proper plate positioning during ORIF of the ulna to reduce the risk of EIP entrapment.

Bunionette deformity, historically known as tailor's bunion, is a forefoot protuberance laterally, dorsolaterally, or plantarlaterally along the fifth metatarsal head. Although bunionette deformity has been compared to hallux valgus deformity, it is likely due to a multifactorial, anatomic interplay between fifth metatarsal bony morphology and forefoot soft-tissue imbalance. Friction generated between the bony prominence, soft tissue, and associated constrictive footwear can result in keratosis, inflammation, pain, and ulceration. Symptomatic bunionettes are usually responsive to nonsurgical management. Surgical options are available based on the underlying bony deformity when nonsurgical treatment fails.

Machine learning (ML) has revolutionized a wide range of recognition tasks, ranging from text analysis to speech to vision, most notably in cloud deployments. However, mobile deployment of these ideas involves a very different category of design problems. In this article, we develop a hardware architecture for a sound source separation task, intended for deployment on a mobile phone. We focus on a novel Markov random field (MRF) sound source separation algorithm that uses expectation-maximization and Gibbs sampling to learn MRF parameters on the fly and infer the best separation of sources. The intrinsically iterative algorithm suggests challenges for both speed and power. A real-time streaming FPGA implementation runs at 150MHz with 207KB RAM, achieves a speed-up of 22× over a software reference, performs with an SDR of up to 7.021dB with 1.601ms latency, and exhibits excellent perceived audio quality. A 45nm CMOS ASIC virtual prototype simulated at 20MHz shows that this architecture is small (

Purpose To make recommendations regarding the use of bisphosphonates and other bone-modifying agents as adjuvant therapy for patients with breast cancer. Methods Cancer Care Ontario and ASCO convened a Working Group and Expert Panel to develop evidence-based recommendations informed by a systematic review of the literature. Results Adjuvant bisphosphonates were found to reduce bone recurrence and improve survival in postmenopausal patients with nonmetastatic breast cancer. In this guideline, postmenopausal includes patients with natural menopause or that induced by ovarian suppression or ablation. Absolute benefit is greater in patients who are at higher risk of recurrence, and almost all trials were conducted in patients who also received systemic therapy. Most studies evaluated zoledronic acid or clodronate, and data are extremely limited for other bisphosphonates. While denosumab was found to reduce fractures, long-term survival data are still required. Recommendations It is recommended that, if available, zoledronic acid (4 mg intravenously every 6 months) or clodronate (1,600 mg/d orally) be considered as adjuvant therapy for postmenopausal patients with breast cancer who are deemed candidates for adjuvant systemic therapy. Further research comparing different bone-modifying agents, doses, dosing intervals, and durations is required. Risk factors for osteonecrosis of the jaw and renal impairment should be assessed, and any pending dental or oral health problems should be dealt with prior to starting treatment. Data for adjuvant denosumab look promising but are currently insufficient to make any recommendation. Use of these agents to reduce fragility fractures in patients with low bone mineral density is beyond the scope of the guideline. Recommendations are not meant to restrict such use of bone-modifying agents in these situations. Additional information at www.asco.org/breast-cancer-adjuvant-bisphosphonates-guideline , www.asco.org/guidelineswiki , https://www.cancercareontario.ca/guidelines-advice/types-of-cancer/breast .

Yacon (Smallanthus sonchifolius) tubers and leaves have been used widely as foodstuff and as remedy for urinary ailments, muscle pain, hyperlipidemia and diabetes mellitus. Recent studies have investigated on isolating active components for their anti-cancer potential against melanoma, cervical cancer and colon cancer. In this study, the cytotoxicity potential of hexane, methanol and DCM extracts of yacon leaves was assessed against MCF-7 (breast cancer), HT-29 (colon cancer) and HDFn (normal human dermal fibroblast) cell lines by using AlamarBlue® assay. Results showed significant reduction in cellular viability of MCF-7 cell lines caused by hexane, methanol and DCM extracts in a dose dependent manner, with DCM being the most potent. The DCM extract also produced significant cytotoxic activity against HT-29 cells, with IC50 lower than 5-fluorouracil. Effect on HDFn showed that three yacon extracts produced significantly lower cytotoxicity compared to drug controls with the DCM extract showing the least toxicity. Key words: Yacon, alamar, breast, colon, cancer, MCF-7, HT-29..

Introduction: Referred to as the “fifth vital sign”, pain is unique in that it cannot be obtained accurately by objective measurements. Instead, providers rely on patient-reported scales, such as the numerical rating scale (NRS), to determine a patient’s pain level. Research has shown that patients report different pain scores to nurses and physicians in the clinic setting. It is unknown if this also occurs in the acute postoperative period. We hypothesized that patients report similar pain scores to the nursing staff and physician postoperatively. The primary aim of this study was to examine the degree of agreement between these patient-reported pain scores. Methods: A prospective study was conducted on 90 postoperative patients. During rounds, the surgeon collected a patient-reported pain score using the 11-point verbal NRS. Following rounds, the nursing staff obtained a pain score using the same scale. The patient was blinded to the study. Results: The median score reported to both the surgeon and nurses was 3 (range: 0-10), with a median difference of 0 (range: -2.5 to 7). Fifty-four percent of patients reported the same score to both the surgeon and the nurse and 88% of patients reported scores within a 1-point difference. This corresponded to an interclass correlation coefficient of 0.90, indicating very good agreement. The degree of agreement in pain scores reported to surgeons and nurses was consistent according to sex and age. Conclusion: The results of the study demonstrate a high degree of agreement between the pain scores reported by the patients to both the nursing staff and the surgeon postoperatively, with 88% of the scores at most being 1-point different.

Case The use of biologics is rapidly expanding. Over the past decade, there has been a significant increase in the number of cash-based "stem cell"/regenerative medicine clinics in the United States. These clinics provide cash-based services touting stem cell injections to cure a myriad of conditions. Largely, these clinics are unregulated and using injections in a non-Food and Drug Administration-approved manner. We report on 2 patients who presented with symptoms suggestive of septic arthritis following stem cell injections by cash-based local stem cell clinics. Case 1 involved a patient who developed septic arthritis following an injection of umbilical cord blood-derived cellular products (Genentech) and required an antibiotic spacer followed by a total hip arthroplasty. Case 2 involved a patient who developed a likely immune-mediated reaction following an injection of morselized human placental allograft tissue by a local chiropractic office at a cost of approximately $8,000. Conclusions We present these cases to bring increased awareness to the issue and call for increased regulation of this practice.

Background: The infrapatellar nerve branch (IPNB) of the saphenous nerve supplies cutaneous sensation to the anterolateral knee. Given its location and variable course, the IPNB is suspected to be at risk of injury with commonly used incisions around the knee. Nerve injury may lead to painful neuroma formation. To our knowledge, no study has evaluated the incidence at which the IPNB is encountered during the anterior approach incision for a routine total knee arthroplasty (TKA). The purpose of this study was to see whether the general joint arthroplasty surgeon can identify and examine the location of the IPNB encountered during primary TKA and to determine whether these branches would be transected during a standard medial arthrotomy. Methods: Seventy-three patients (76 knees) underwent primary TKA using a standard midline approach with a medial parapatellar arthrotomy. The IPNB was identified, and the distance was measured from the inferior pole of the patella to the point where the nerve crossed the medial border of the patellar tendon. This distance was then compared with the length of the arthrotomy in the same knee to determine whether the nerve would be transected. Results: The IPNB was encountered in all knees with a mean distance of 2.82 cm (95% confidence interval, 2.58–3.06) distal to the inferior pole of the patella during the arthrotomy. Patient characteristics including sex, height, and body mass index were not markedly associated with nerve location. Conclusion: The IPNB of the saphenous nerve is at risk for injury and routinely encountered by the general orthopaedic surgeon during a standard TKA medial parapatellar approach without the aid of magnification or dye.

Category: Professional, Patient Care Introduction/Purpose: Differences exist in the training backgrounds of medical providers who treat foot and ankle disorders. Considerable overlap and similarities also exist between podiatric and orthopaedic surgeons, though patients may be unaware of the differences. It is not known to what extent professional training influences how patients seek care. The purpose of this study is to understand patients’ knowledge of the differences in professional training background between podiatry and orthopedic surgery and to determine which factors are important to patients when selecting a provider. Methods: Patient survey data was gathered from Froedtert Memorial Lutheran Hospital and the Mayo Clinic. A 27-question survey was administered to new patients who were referred to the foot and ankle service in an orthopedic department at both institutions. Survey questions included data on patient demographics, patient opinion, and knowledge of differences between podiatry, orthopedics, and other foot and ankle providers. Patients were grouped by provider preference. Univariate and multivariate regressions were used to characterize the study population and determine provider preference. Significance was determined through t-tests, Fisher’s Exact test, and chi-square tests. Results: Of the 169 patients who completed the entire survey, 99 chose “orthopedic surgeon” as their provider of preference for any foot or ankle injury. Between the groups, there was no significant difference in age, healthcare affiliation, previous podiatric visits, level of education, and perceived knowledge about the differences between the two specialties (Table 1). For patients who listed podiatry as their preference, they were less likely to expect their doctor to have completed residency (76.2% vs. 90.7-94.9%, p=0.03). Patients preferred an orthopedic surgeon over a podiatrist for ankle (63.3% vs. 9.5%, pConclusion: Foot and ankle patients have poor understanding of the different medical and surgical training backgrounds between a podiatrist and orthopedic surgeon. The majority of patients believe podiatrist and orthopaedic surgeons have the same professional training. However, patients also believed orthopaedic surgeons have a longer training period, though it was still underestimated by three years. Patients preferred care for podiatrist with conditions affecting the toes and orthopaedic surgeons for all other conditions.

Introduction: Opioid pain medications are commonly prescribed following orthopedic procedures, with overprescribing of these pain medications implicated as a driver of the current opioid epidemic. In an effort to reduce reliance on opioid pain medications, surgeons are relying on periarticular injections or peripheral nerve blocks. The purpose of this study was to compare numerical rating scale (NRS) pain scores and oral morphine equivalents (OMEs) in patients who underwent primary total knee arthroplasty (TKA) with a periarticular injection alone to those who underwent a collaborative approach with a periarticular injection in the posterior tissue and an adductor canal catheter for anterior knee analgesia. Methods: In this study, 236 patients underwent a primary TKA between December 2017 and April 2018. Forty patients received an adductor canal catheter and 196 underwent a periarticular injection alone. Results: We found no difference in patient demographics between the cohorts (p>0.05). The patients that underwent the collaborative approach with a periarticular injection and adductor canal catheter had lower NRS pain scores on post-operative day 0, 1, and 2 (all P≤0.033). These patients demonstrated a reduction of 43% in opioid consumption during the hospitalization (P

Introduction Total knee arthroplasty (TKA) is a common procedure with significant advances over the past several years, many pertaining to improved perioperative pain control. Cryotherapy is one method thought to decrease swelling and pain postoperatively. To our knowledge no study has directly visualized the effect cryotherapy has on skin blood flow following TKA. The primary aim was to determine if cryotherapy (icing) affects peri-incisional skin blood flow and if this is lessened with an alternate placement of the ice. We hypothesized that blood flow would decrease following cryotherapy, and this decrease would be greater with ice placed directly over the incision as compared to placement along the posterior knee. Methods This study included 10 patients who underwent TKA. During the postoperative hospitalization, they were given an injection of indocyanine green dye. A baseline image was recorded of the skin blood flow. Images were then collected following a five-minute interval placement of ice over the incision. The experiment was then repeated with the ice placed along the posterior knee. Results There was an approximate 40% decrease in skin blood flow following placement of the ice compared to baseline. We observed a greater decrease in blood flow when ice was placed over the incision as compared to when ice was placed posterior to the knee (p ≤ 0.020). Conclusion We found a significant decrease in peri-incisional blood flow with icing of the knee. Physicians should be cognizant of this when recommending cryotherapy to patients after surgery, especially in at-risk wounds.

BACKGROUND Quadriceps tendon rupture following total knee arthroplasty (TKA) is an infrequent but potentially devastating adverse event. Although uncommon, the long-term sequelae of this injury can result in permanent inability to walk. Despite the severity of this injury, there is no single accepted treatment, with various surgical methods producing mixed results. Therefore, the purpose of this study was to assess the efficacy of a modified V-Y turndown flap as a viable alternative method of treatment for this injury. METHODS Twenty-four quadriceps tendon ruptures in 23 patients (10 men and 13 women) who underwent TKA (8 primary and 15 revision), including 1 tendon rerupture, were treated with use of a modified V-Y turndown. The average patient age at the time of the V-Y flap repair was 61 years (range, 41 to 86 years). Knee Society scores, range of motion, strength, medical comorbidities, nature of the procedure (i.e., primary versus revision), and the ability to walk were all recorded before and after the quadriceps reconstruction, along with general satisfaction and adverse events following the procedure. RESULTS Twelve patients (52%) had predisposing comorbidities, including obesity, diabetes, chronic dialysis, and steroid dependence. Prior to repair with the V-Y flap, none of the patients were able to walk independently, requiring either a wheelchair or walker. No patient had quadriceps strength greater than 3 (of 5), although all had full passive extension. Following the repair procedure, patients had significant (p < 0.0001) improvements in mean Knee Society knee score (88.7; range, 45 to 95) and mean strength (4.8; range, 3 to 5), and all were able to walk without assistive devices. Twenty knees exhibited active range of motion of 0° to 120°, whereas 4 had residual extensor lag of ≥5° (range, 5° to 35°). Major adverse events were limited to a single hematoma and an unacceptable extensor lag (35°) after repair. CONCLUSIONS The modified V-Y quadriceps tendon turndown flap was a reliable alternative treatment for achieving restoration of the extensor mechanism after complete quadriceps tendon rupture following TKA. LEVEL OF EVIDENCE Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Many consider one of the key components to the success of deep learning as its compatibility with existing accelerators, mainly GPU. While GPUs are great at handling linear algebra kernels commonly found in deep learning, they are not the optimal architecture for handling unsupervised learning methods such as Bayesian models and inference. As a step towards, achieving better understanding of architectures for probabilistic models, Gibbs sampling, one of the most commonly used algorithms for Bayesian inference, is studied with a focus on parallelism that converges to the target distribution and parameterized components. We propose FlexGibbs, a reconfigurable parallel Gibbs sampling inference accelerator for structured graphs. We designed an architecture optimal for solving Markov Random Field tasks using an array of parallel Gibbs samplers, enabled by chromatic scheduling. We show that for sound source separation application, FlexGibbs configured on the FPGA fabric of Xilinx Zync CPU-FPGA SoC achieved Gibbs sampling inference speedup of 1048x and 99.85% reduction in energy over running it on ARM Cortex-A53.

The recent surge of machine learning has motivated computer architects to focus intently on accelerating related workloads, especially in deep learning. Deep learning has been the pillar algorithm that has led the advancement of learning patterns from a vast amount of labeled data, or supervised learning. However, for unsupervised learning, Bayesian methods often work better than deep learning. Bayesian modeling and inference works well with unlabeled or limited data, can leverage informative priors, and has interpretable models. Despite being an important branch of machine learning, Bayesian inference generally has been overlooked by the architecture and systems communities. In this paper, we facilitate the study of Bayesian inference with the development of BayesSuite, a collection of seminal Bayesian inference workloads. We characterize the power and performance profiles of BayesSuite across a variety of current-generation processors and find significant diversity. Manually tuning and deploying Bayesian inference workloads requires deep understanding of the workload characteristics and hardware specifications. To address these challenges and provide high-performance, energy-efficient support for Bayesian inference, we introduce a scheduling and optimization mechanism that can be plugged into a system scheduler. We also propose a computation elision technique that further improves the performance and energy efficiency of the workloads by skipping computations that do not improve the quality of the inference. Our proposed techniques are able to increase Bayesian inference performance by 5.8 × on average over the naive assignment and execution of the workloads.

Heterotopic ossification has been reported to occur after musculoskeletal trauma (including orthopedic procedures). This has been known to cause nerve entrapment syndromes and persistent pain, limiting joint mobility. We present a case of a 19-year old female collegiate athlete who had previously undergone ankle arthroscopy and arthrotomy to remove 2 ossicles. At approximately 1 year postoperatively, the patient developed pain when planting and pivoting her foot. Imaging revealed a radiodense lesion at the posteromedial ankle consistent with heterotopic ossification and entrapment of the tibial nerve within the tarsal tunnel. The patient underwent surgical resection and postoperative indomethacin prophylaxis. At the 1-year follow-up visit, the patient remained asymptomatic, without evidence of recurrence of the heterotopic ossification. In our review of the published data, we found no previously reported cases of heterotopic ossification causing entrapment of the tibial nerve within the tarsal tunnel. In the present case report, we describe this rare case and the postulated etiologies and pathophysiology of this disease process. In addition, we discuss the clinical signs and symptoms and recommended imaging modalities and treatment.

We focus on utilizing sputtered indium tin oxide (ITO) as a recombination layer, having low junction damage to an n-type silicon solar cell with a front-side tunnel oxide passivating electron contact, thereby enabling the development of a high efficiency monolithic perovskite/Si tandem device. High transparency and low resistivity ITO films are deposited via low power DC magnetron sputtering at room temperature onto a front-side thin SiOx/n+ poly-Si contact in a complete Cz n-Si cell with a back-side Al2O3/SiNx passivating boron-diffused p+-emitter on a random pyramid textured surface. We report the cell characteristics before and after ITO sputtering, and we find a cure at 250 °C in air is highly effective at mitigating any sputtering induced damage. Our ITO coated sample resulted in an implied open-circuit voltage (iVoc) of 684.7 ± 11.3 mV with the total saturation current density of 49.2 ± 14.8 fA/cm2, an implied fill factor (iFF) of 81.9 ± 0.8%, and a contact resistivity in the range of 60 mΩ-cm2 to 90 mΩ-cm2. After formation of a local Ag contact to the rear emitter and sputtered ITO film as the front-side contact without grid fingers, the pseudo-efficiency of 20.2 ± 0.5% was obtained with the Voc of 670.4 ± 7 mV and pseudo FF of 77.3 ± 1.3% under simulated one sun with the calculated short-circuit current density of 30.9 mA/cm2 from the measured external quantum efficiency. Our modelling result shows that efficiency exceeding 25% under one sun is practically achievable in perovskite/Si tandem configuration using the ITO recombination layer connecting a perovskite top cell and a poly-Si bottom cell.

The United States is combating an opioid epidemic. Orthopedic surgeons are the third highest opioid prescribers and therefore have an opportunity and obligation to assist in the efforts to reduce opioid use and abuse. In this article, we evaluate risk factors for patients requiring an opioid refill after primary total knee arthroplasty, with the goal to reduce opioid prescriptions for those patients at low risk of requiring a refill in order to reduce the amount of unused medication.We retrospectively reviewed narcotic-naïve patients who underwent total knee arthroplasty from December 2017 to May 2018. We performed multivariable analysis on demographics and preoperative, operative, and postoperative characteristics to determine risk factors for requiring a prescription refill following hospital discharge.One-hundred fifty-seven patients were included in the analysis. Sixty percent of patients required a prescription refill. Risk factors included younger age (P = .003) and increased pain on postoperative day one (P.001). The amount of narcotic medication given at discharge did not independently affect the refill rate (P = .21).There is strong evidence that elderly patients and those with good pain control on postoperative day 1 are at a lower risk of requiring a narcotic refill postoperatively. With this information, physicians may begin to tailor narcotic prescriptions based on patient risk factors for requiring a prescription refill rather than provide patients with the same number of pills for a given surgery in an effort to reduce unused narcotic medication.

Science communicators and scholars have struggled to understand what appears to be increasingly frequent endorsement of a wide range of anti-science beliefs and a corresponding reduction of trust in science. A common explanation for this issue is a lack of science literacy/knowledge among the general public (Funk et al. 2015). However, other possible explanations have been advanced, including conflict with alternative belief systems and other contextual factors, and even cultural factors (Gauchat 2008; Kahan 2015) that are not necessarily due to knowledge deficits. One of the challenges is that there are limited tools available to measure a range of possible underlying negative perceptions of science that could provide a more nuanced framework within which to improve communication around important scientific topics. This project describes two studies detailing the development and validation of the Negative Perceptions of Science Scale (NPSS), a multi-dimensional instrument that taps into several distinct sets of negative science perceptions: Science as Corrupt, Science as Complex, Science as Heretical, and Science as Limited. Evidence for the reliability and validity of the NPSS is described. The sub-dimensions of the NPSS are associated with a range of specific anti-science beliefs across a broad set of topic areas above and beyond that explained by demographics (including education, sex, age, and income), political, and religious ideology. Implications for these findings for improving science communication and science-related message tailoring are discussed.

Background:Postoperative incomplete reduction of the sesamoids has been identified as a potential risk factor for hallux valgus recurrence after proximal osteotomy. However, it is not known whether the postoperative sesamoid position is a risk factor in hallux valgus correction via distal chevron osteotomy with or without dorsal webspace release (DWSR).Methods:In this retrospective study, 169 patients who underwent distal chevron osteotomy with or without DWSR were reviewed. Preoperative and postoperative (6 weeks, 6 months, 12 months) weightbearing radiographs were evaluated. Functional hallux valgus angle (HVA), intermetatarsal angle (IMA), and the position of the tibial sesamoid were graded using the center of head method. Seventy-six radiographs were available for review at the 12-month follow-up. Of these, 41 patients underwent DWSR procedure and 35 did not.Results:In both groups, correction of all 3 parameters (HVA, IMA, tibial sesamoid position) were significant at the 12-month follow-up. Comparison of the postoperative results of the 2 groups showed no statistically significant differences. Four feet demonstrated displaced sesamoid position at the 12-month follow-up, with radiographic evidence of recurrence in just one. No significant relationship was found between postoperative sesamoid position and hallux valgus recurrence that occurred in 4 feet.Conclusion:Combining DWSR with a distal chevron osteotomy did not delay healing or increase risk of avascular necrosis, but it did not significantly improve angular measurements or sesamoid position. The concept that postoperative sesamoid position can be used to predict hallux valgus recurrence was not supported by our results when looking at distal chevron correction.Level of Evidence:Level III, retrospective comparative study.

Surgical options for treatment of tibiotalar, subtalar, and trans verse tarsal joint arthritis are limited. Pantalar arthrodesis can produce a stable and braceable if not painless foot in the planti grade position. This article presents a review of etiology, clinical evaluation, procedural technique and outcomes reported in literature. Shi G, Gross CE, Huh J, Parekh SG. Pantalar Arthrodesis: Surgical Technique and Review of Literature. The Duke Orthop J 2015;5(1):4852.

Subtalar arthrodesis is considered to be the gold standard surgical solution for end-stage subtalar joint arthrosis. Although subtalar joint fusion rates are high, nonunion has been reported to range from 0% to 43%. Revision subtalar arthrodesis regardless of etiology often requires removal of loose hardware in soft bone. The inability of screw threads to engage bone may result in longer operative time, frustration for the surgeon, and potential negative outcome for the patient. We describe a novel technique in which a cannulated drill bit is used as a tamp to remove subtalar arthrodesis screws. We have found this method to be efficient and safe and transferable to any extremity. Levels of Evidence: Therapeutic, Level V: Expert opinion

We explore sound source separation to isolate human voice from background noise on mobile phones, e.g. talking on your cell phone in an airport. The challenges involved are real-time execution and power constraints. As a solution, we present a novel hardware-based sound source separation implementation capable of real-time streaming performance. The implementation uses a recently introduced Markov Random Field (MRF) inference formulation of foreground/background separation, and targets voice separation on mobile phones with two microphones. We demonstrate a real-time streaming FPGA implementation running at 150 MHz with total of 207 KB RAM. Our implementation achieves a speedup of 20× over a conventional software implementation, achieves an SDR of 6.655 dB with 1.601 ms latency, and exhibits excellent perceived audio quality. A virtual ASIC design shows that this architecture is quite small (less than 10M gates), consumes only 69.977 mW running at 20 MHz (52× less than an ARM Cortex-A9 software reference), and appears amenable to additional optimization for power.

OBJECTIVE: To examine the effectiveness of a health promotion flyer to increase awareness of breast cancer risk and physical activity as a risk reduction strategy in young adult women. METHODS: Young adult women (N = 123) viewed one of five health promotion flyers online and then completed measures of perceived breast cancer risk (PR) and perceived informativeness (PI) and a qualitative thought-listing activity. RESULTS: Differences were observed in PI such that the control and low risk/low information messages were significantly less informative than the others. Qualitative analyses revealed two general themes: message content and flyer design. Additional analyses of the flyer design comments revealed four sub-themes: negative thoughts about the image, positive thoughts about the image, misunderstanding breast cancer risk information, and social comparison. Exploratory analyses controlling for message type indicated that image appraisal predicted PI such that those who commented on the image found the flyer to be less informative. DISCUSSION: Results suggest that the flyer was informative but did not impact young women’s breast cancer risk perceptions. Additionally, the image may have distracted young women from the intended message. Evaluating the acceptability of images used in health promotion materials is recommended before testing the effectiveness of the intervention.