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BackgroundPeople of low socioeconomic position (SEP) are disproportionately affected by type 2 diabetes (T2D), partly due to unhealthy eating patterns that contribute to inadequate disease self-management and prognosis. Digital technologies have the potential to provide a suitable medium to facilitate diabetes education, support self-management, and address some of the barriers to healthy eating, such as lack of nutritional knowledge or shopping or cooking skills, in this target group. ObjectiveThis study aims to test the feasibility, appeal, and potential effectiveness of EatSmart, a 12-week, evidence-based, theoretically grounded, fully automated web-based and mobile-delivered healthy eating behavior change program to help disadvantaged people living with T2D to eat healthily on a budget and improve diabetes self-management. MethodsEatSmart is a mixed methods (quantitative and qualitative) pre-post design pilot study. Sixty socioeconomically disadvantaged people with T2D aged 18 to 75 years will be recruited. Participants will complete self-reported baseline assessments of their basic demographic and clinical data, dietary intake, dietary self-efficacy, and barriers to healthy eating. They will be provided with login access to the EatSmart web program, which includes six progressive skill-based modules covering healthy eating planning; smart food budgeting and shopping; time-saving meal strategies, healthy cooking methods, modifying recipes; and a final reinforcement and summary module. Over the 3-month intervention, participants will also receive 3 text messages weekly, encouraging them to review goals, continue to engage with different components of the EatSmart web program, and eat healthily. Participants will undertake follow-up assessments directly following the intervention 3 months post baseline and again after a 6-month postintervention follow-up period (9 months post baseline). Feasibility will be evaluated using the number of participants recruited and retained and objective indicators of engagement with the website. Program appeal and potential effects on primary and secondary outcomes will be assessed via the same surveys used at baseline, with additional questions asking about experience with and perceptions of the program. In-depth qualitative interviews will also be conducted 6 months post intervention to provide deeper insight into experiences with EatSmart and a more comprehensive description of the program’s appeal. ResultsThe EatSmart website has been developed, and all participants have viewed the modules as of May 2020. Results are expected to be submitted for publication in December 2020. ConclusionsThis study will provide data to address the currently limited evidence regarding whether disadvantaged populations with T2D may benefit from digitally delivered behavior change programs that facilitate eating healthily on a budget. Trial RegistrationAustralian New Zealand Clinical Trials Registry, ACTRN12619001111167; https://anzctr.org.au/Trial/Registration/TrialReview.aspx?ACTRN=12619001111167 International Registered Report Identifier (IRRID)DERR1-10.2196/19488

Issues Addressed: The presence or absence of amenities in local neighbourhood environments can either promote or restrict access to opportunities to engage in healthy and/or less healthy behaviours. Rurality is thought to constrain access to facilities and services. This study investigated whether the presence and density of environmental amenities related to physical activity and eating behaviours differs between socioeconomically disadvantaged urban and rural areas in Victoria, Australia.Methods: We undertook cross-sectional analysis of environmental data collected in 2007-08 as part of the Resilience for Eating and Activity Despite Inequality (READI) study. These data were sourced and analysed for 40 urban and 40 rural socioeconomically disadvantaged areas. The variables examined were the presence, raw count, count/km2, and count/'000 population of a range of environmental amenities (fast-food restaurants, all supermarkets (also separated by major chain and other supermarkets), greengrocers, playgrounds, gyms/leisure centres, public swimming pools and public open spaces).Results: A greater proportion of urban areas had a fast-food restaurant and gym/leisure centre present while more rural areas contained a supermarket and public swimming pool. All amenities examined (with the exception of swimming pools) were more numerous per km2 in urban areas, however rural areas had a greater number of all supermarkets, other supermarkets, playgrounds, swimming pools and public open space per '000 population.Conclusion: Although opportunities to engage in healthy eating and physical activity exist in many rural areas, a lower density per km2 suggests a greater travel distance may be required to reach these. [ABSTRACT FROM AUTHOR]

We performed a retrospective review of elective orthopedic surgeries performed at our institution in 2008. Surgical wait time was defined as the interval between when surgery was offered and when it was performed. Data were available for 1,120 patients and included date and type of procedure, patient age, American Society of Anesthesia (ASA) category, and military rank. Mean wait time for all procedures was 69.1 days. Significant differences were found with regard to patient age, ASA class, rank, and type of procedure. Older patients with higher ASA had significantly longer wait times. Enlisted soldiers had the shortest wait times and retirees the longest. Total joint procedures had the longest wait time (mean 140 days) and the highest anesthesia class. Elective trauma procedures had the shortest wait time (mean 27.2 days). Sports procedures accounted for 46.3% of all cases reviewed. In our cohort, older patients with higher ASA class and those undergoing a total joint procedure can expect longer preoperative wait times. No preferential care given to officers, as enlisted soldiers had the shortest wait times. At our military medical center, which closely models a managed care system, patients can expect to wait more than 2 months for elective orthopedic surgeries. [ABSTRACT FROM AUTHOR]

Objective: The objective of this study is to retrospectively review the preoperative data compared to the patient's length of hospital stay (LOHS) and discharge disposition to home or a skilled nursing facility (SNF) following primary total knee arthroplasty.Methods: Preoperative data on 383 patients included year and day of the week of the surgery, patient age, body mass index (BMI), American Society of Anesthesiologists (ASA) class, and gender.Results: Mean LOHS for all patients was 4.35 days. Three hundred and twenty-eight patients were discharged to home and 55 patients were discharged to a SNF. Factors found to be statistically significant with increased LOHS were increased age, increased ASA class, decreased BMI, and year of admission before instituting a "pathway" program. Factors significant for discharge to a SNF were increased age and ASA class.Conclusion: Older patients with higher ASA class have longer LOHS and increased discharges to a SNF. Patients whose surgery was performed after instituting a "pathway" program and those with higher BMI had a decreased LOHS. [ABSTRACT FROM AUTHOR]

Cytogenetic abnormalities in the Prader-Willi/Angelman syndrome (PWS/AS) critical region have been described in individuals with autism. Maternal duplications and linkage disequilibrium in families with autism suggest the existence of a susceptibility locus at 15q11-q13. Here, we describe a 6-year-old girl diagnosed with autism, developmental delay, and delayed expressive and receptive language. The karyotype was designated de novo 47, XX, idic(15)(q13). Fluorescence in situ hybridization (FISH) and molecular analysis with 15q11-q13 markers revealed an additional copy of the region being of maternal origin. Duplication of the 15q11-q13 segment represents the most consistent known chromosomal abnormality reported in association with autism. This present case report reinforces the hypothesis that additional copies of this chromosome segment are causally related to autism. [ABSTRACT FROM AUTHOR]

Objective: To examine perceptions of success in weight control and future weight-control intentions in a community sample.Design: Cross-sectional postal survey.Subjects: There were 1500 adults randomly selected from the Electoral Roll of Victoria (47% response). Setting: Community.Main outcome measures: Retrospective weight change over previous 12 months; perceived weight-control success; future weight-control intentions.Statistical analyses: Pearson's chi2 tests were used to compare perceived weight-control success by sex, and by age, education level, initial BMI, amount of weight change and weight-loss behaviour within sex. ANOVA was used to compare mean weight change associated with perceived weight control success within sex, and within age, education, body mass index and weight-loss behaviour by sex. The distribution (frequency) of weight-control intentions are reported within perceived weight-control success and amount of weight change.Results: One in two (53%) reported maintaining their weight within 1kg in the preceding 12 months, 26% of men and 21% of women reported weight gain and 20% of men and 26% of women reported weight loss. Almost one-third (30%) of those who maintained their weight considered themselves unsuccessful. A majority of those who lost weight considered themselves successful at controlling their weight. However, more than 45% of men who gained weight also considered themselves successful. Those who considered themselves unsuccessful experienced less weight loss (1.1 +/- 3.9kg) than those who considered themselves quite successful (-1.4 +/- 4.5 kg, P < 0.001) or very successful (-1.3 +/- 7.8 kg, P < 0.001). [ABSTRACT FROM AUTHOR]

Children's nurses deal with the family on a daily basis. There are many theories about the family, and there is good supporting evidence focusing on the family as it interacts with healthcare professionals. Modern technology and the structure of today's society have influenced the way families function. This article considers some of the cornerstone theories about the family, looks at family stages, relates these to the healthcare setting and in particular examines the family under stress. Each family is (or has the potential to be) a unique dynamic, functional system of childrearing, care and support for its members. Children are often admitted to hospital for short periods or can be discharged home while still fairly dependent. This can mean a heavy family commitment, and how the family functions results in several issues for children's nurses to reflect on. It is too simplistic to state that standards of care depend on how the family copes under pressure, but undoubtedly this would have some influence. Children's nurses need to be able to assess the family in order to promote coping and to equip the family to deal with the stresses of extraordinary care demands, which can result in having a sick or dependent child at home. The aim should be to enable the family to find the caring experience a positive one and to be able to keep a balance and a quality to family life so that all the family members' needs are met. [ABSTRACT FROM AUTHOR]

BackgroundThere is a critical need for weight management programs that are effective, cost efficient, accessible, and acceptable to adults from diverse ethnic and socioeconomic backgrounds. mHealth (delivered via mobile phone and Internet) weight management programs have potential to address this need. To maximize the success and cost-effectiveness of such an mHealth approach it is vital to develop program content based on effective behavior change techniques, proven weight management programs, and closely aligned with participants’ needs. ObjectiveThis study aims to develop an evidence-based mHealth weight management program (Horizon) using formative research and a structured content development process. MethodsThe Horizon mHealth weight management program involved the modification of the group-based UK Weight Action Program (WAP) for delivery via short message service (SMS) and the Internet. We used an iterative development process with mixed methods entailing two phases: (1) expert input on evidence of effective programs and behavior change theory; and (2) target population input via focus group (n=20 participants), one-on-one phone interviews (n=5), and a quantitative online survey (n=120). ResultsExpert review determined that core components of a successful program should include: (1) self-monitoring of behavior; (2) prompting intention formation; (3) promoting specific goal setting; (4) providing feedback on performance; and (5) promoting review of behavioral goals. Subsequent target group input confirmed that participants liked the concept of an mHealth weight management program and expressed preferences for the program to be personalized, with immediate (prompt) and informative text messages, practical and localized physical activity and dietary information, culturally appropriate language and messages, offer social support (group activities or blogs) and weight tracking functions. Most target users expressed a preference for at least one text message per day. We present the prototype mHealth weight management program (Horizon) that aligns with those inputs. ConclusionsThe Horizon prototype described in this paper could be used as a basis for other mHealth weight management programs. The next priority will be to further develop the program and conduct a full randomized controlled trial of effectiveness.

OBJECTIVE: To examine the associations between potential social ecological correlates and self-reported short physical activity breaks during work hours (defined as any interruption in sitting time during a typical work hour) among a sample of employees who commonly sit for working tasks. METHODS: 801 employed adults aged 18-70years from metropolitan Melbourne, Australia were surveyed in 2009 about their short physical activity breaks from sitting during work hours and potential social ecological correlates of this behaviour. RESULTS: Men reported significantly more short physical activity breaks per work hour than did women (2.5 vs. 2.3 breaks/h, p=0.02). A multivariable linear regression analysis adjusting for clustering and meeting the public health physical activity recommendations showed that the factors associated with frequency of short physical activity breaks per work hour were perceptions of lack of time for short physical activity breaks for men (-0.31 breaks/h, 95% confidence intervals [CI] -0.52, -0.09) and lack of information about taking short physical activity breaks for women (-0.20 breaks/h, CI -0.47, -0.05). CONCLUSION: These findings suggest that providing male employees with support for short physical activity breaks during work hours, and female employees with information on benefits of this behaviour may be useful for reducing workplace sedentary time. [ABSTRACT FROM AUTHOR]

Introduction: Utilization of the direct anterior approach (DAA) for total hip arthroplasty (THA) has been steadily increasing in recent years. While the DAA may offer some benefits compared to other approaches, there are still risks involved including relatively higher rates of periprosthetic femur fractures, especially when combined with cementless femoral stem use. The purpose of this study is to evaluate the early postoperative femoral complications with a short triple-wedge tapered stem used in primary THA via a DAA., Materials and Methods: A retrospective review was conducted of the arthroplasty registry of our institution from April 2022 to August 2023 to identify patients who underwent a primary THA via a DAA with the Short Medacta Stem (SMS) (Medacta International, Castel San Pietro, Switzerland). Patients were excluded if the stem was used for a revision surgery, they were within 90 days of surgery, or they refused research consent. Inclusion criteria was met in 262 patients (302 hips). Data was collected after reviewing the chart, and reports and radiographic measurements, including Dorr type and canal fit ratios, were obtained from preoperative and postoperative radiographs, respectively., Results: A total of 302 total hips were included, 161 patients were male (53.3%) and 141 were female (46.7%), with an average age of 66.5 years (27-88, +/- 10.7 years). Average follow up was 0.3 years (range, 0.05-1.71 years). The majority of patients had a Dorr B femur (81.7%). The Median stem size used was an 8 (range, 2-15), and 89.4% of those had a collar. Average canal fill ratio was 0.83 (range, 0.43-0.98, +/- 0.07). Overall, there were two Vancouver B2a periprosthetic femoral shaft fractures (0.66%) that required revision surgery to a modular stem. In addition, there were two Vancouver Ag greater trochanteric fractures (0.66%) with acceptable alignment that did not require revision surgery. Demographic information about the patients with femoral complications is summarized in Table I. Average age of patients with femoral complications was 69.5 years, with an average canal fit ratio of 0.88., Conclusion: We found that the triple-wedge implant had a low rate of early femoral complication in primary THA from an anterior approach and is safe for use in THA from a DAA. More follow up is needed to evaluate continuing implant survivorship and patient outcomes.

The current study is part of a community engaged planning phase and aimed to identify perceptions related to the prevalence of violent crime, crime contributors, the relationship between the community and law enforcement, and potential interventions and solutions. In March 2021, semistructured interviews were conducted with individuals from five groups who resided or worked in Bessemer, Alabama: (1) Law Enforcement, (2) Residents, (3) Civic Leaders, (4) Community Leaders, and (5) Victims of Crime. Interviews lasted approximately 60 min and were audio recorded, transcribed, and analyzed according to the guidelines of thematic analysis using NVivo 12. Emerging themes were examined in accordance with the CDC Social-Ecological Model: A Framework for Prevention. Participants (N = 18) were 50.0% female and 77.8% African American with an age range of 25-59 (mean = 43.4 years). Themes that emerged related to crime were: (1) impact, (2) contributors, and (3) solutions. Results indicate that impacts of violent crime at the individual level focused on fear, which led to widespread mental health issues. Relationship level impacts included a lack of trust of law enforcement and neighbors, and community level impacts were decreased neighborhood social cohesion as well as decreased safety. At the societal level, the poor reputation of the city was consistently highlighted. For contributors of crime, being a youth under age 30, drugs, and money were discussed as factors at the individual level. At the relationship level, participants mentioned poor parenting and gangs as crime contributing factors to violent crime. Furthermore, contributing issues related to underresourced schools as well as a poor relationship with law enforcement were brought up at the community level. Similarly, poverty was the overarching contributing issue at the societal level. Solutions that emerged included: education and training in life skills, focusing on young people, family/parenting, conflict resolution programs, programs within schools, improved relationships with law enforcement, and inclusive economic opportunities. Intervention plans are discussed that can merge these stakeholder findings with other data sources., (© 2024 Wiley Periodicals LLC.)

Abstract: Philipp, NM, Crawford, DA, Cabarkapa, D, and Fry, AC. Strength and power thresholds to identify high and low linear sprint speed performers in collegiate American football players. J Strength Cond Res 38(1): 74-79, 2024-Lower-body strength and power are commonly measured performance qualities across a number of sports. In recent years, more attention has been given to relationships, primarily between lower-body strength and linear speed performance. While still limited, evidence is in agreement that lower-body strength positively contributes to linear speed performance. However, what is less well understood is if there comes a point in an athlete's development, at which, further working on increasing maximal strength may not fully compliment additional gains in speed performance. Within this study, authors aimed to provide practitioners with lower-body strength and power thresholds that can discriminate between slow and fast performers, within a group of collegiate American football players. The sample was further divided into a high-body and low-body weight group, and authors hypothesized that by using logistic regression, supplemented with receiver operator curve analyses, optimal cut-off points (i.e., relative lower-body strength thresholds) that are able to significantly discriminate between slow and fast linear speed performers may be identified. Findings indicate that optimal cut-off scores differed between the groups of athletes, as well as the lower body strength and power tests. All models were able to significantly distinguish between slower and faster performers, and area under the curve values ranged from 0.695 to 0.903. Although thresholds will likely vary based on factors such as sex, training age, and sport, findings from this investigation may be used to benchmark athletes and to further individualize training aimed at improving linear speed performance., (Copyright © 2023 National Strength and Conditioning Association.)

Physical activity (PA) is suggested to reduce osteoarthritis pain; however, it may be avoided by patients requiring arthroplasty. Our goal was to investigate objective and patient-reported outcomes as a function of pre-operative PA levels in patients undergoing total knee arthroplasty (TKA). A total of 1941 patients enrolled in a multicenter prospective cohort study investigating a smartphone-based care management platform for self-directed rehabilitation underwent TKA and were included in the analysis. Activity was categorized based on the cohort's step count quartiles into low, moderate, and high pre-operative PA. Pre-operative and post-operative pain, EQ5D5L, KOOS JR, and step counts were compared by ANOVA according to activity group. Pre-operative pain scores increased with the decreasing activity level (all, p < 0.05) and were most improved post-operatively in the low PA group. High PA patients demonstrated the smallest improvements in EQ-5D-5L and KOOS JR. Low and moderate PA patients increased physical activity by three months, reaching 176% and 104% of pre-operative steps; high PA patients did not return to full step counts by one year post-operatively. Patients undergoing TKA who present with higher levels of physical activity report lower levels of pain and higher function pre-operatively but appreciate less improvement up to one year post-operatively. These results may be helpful in appropriate counseling of patient expectations before TKA.

Prostaglandin E2 (PGE2) is a signaling molecule produced by cyclooxygenase-2 (COX-2) that is important in healthy brain development. Anomalies in the COX-2/PGE2 pathway due to genetic or environmental factors have been linked to Autism Spectrum Disorders (ASD). Our previous studies showed that COX-2 deficient (COX-2 - KI) mice exhibit sex-dependent molecular changes in the brain and associated autism-related behaviors. Here, we aim to determine the effect of COX-2 - KI on microglial density and morphology in the developing brain. Microglia normally transition between an amoeboid or ramified morphology depending on their surroundings and are important for the development of the healthy brain, assisting with synaptogenesis, synaptic pruning, and phagocytosis. We use COX-2 - KI male and female mice to evaluate microglia density, morphology, and branch length and number in five brain regions (cerebellum, hippocampus, olfactory bulb, prefrontal cortex, and thalamus) at the gestational day 19 (G19) and postnatal day 25 (PN25). We discovered that COX2 - KI females were affected at G19 with increased microglial density, altered percentage of amoeboid and ramified microglia, affected branch length, and decreased branching networks in a region-specific manner; these effects persisted to PN25 in select regions. Interestingly, while limited changes were found in G19 COX-2 - KI males, at PN25 we found increased microglial density, higher percentages of ramified microglia, and increased branch counts, and length observed in nearly all brain regions tested. Overall, we show for the first time that the COX-2 deficiency in our ASD mouse model influences microglia morphology in a sex- and region- and stage-dependent manner., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 IBRO. Published by Elsevier Ltd. All rights reserved.)

The Army Combat Fitness Test (ACFT) is a multi-event assessment battery designed to determine the combat readiness of U.S. Army personnel. However, for Reserve Officers' Training Corps (ROTC) programs the logistical demands of collegiate life make repeated administration of the ACFT challenging. The present study sought to design and evaluate a single, multimodal exercise tolerance test (METT) capable of serving as a time-efficient proxy measure of combat readiness., Methods: Using a formal instrument design process, we constructed the METT to mimic the demands of the ACFT and assessed its reliability, validity, and responsiveness., Results: The METT demonstrates minimal measurement error (i.e., a 2% coefficient of variation), concurrent validity with the ACFT (R 2 = 0.327, F = 10.67, p < 0.001), the ability to classify cadets who may be at-risk for failing the ACFT (X 2 = 8.16, p = 0.017, sensitivity = 0.878, specificity = 0.667), and appropriate change following a training intervention (5.69 ± 8.9%)., Conclusions: The METT has the potential to provide a means to monitor progress, identify areas for improvement, and guide informed decision-making regarding individualization of cadet combat training plans.

Background: The purpose of this study is to assess the viability of a knee arthroplasty prediction model using 3-view X-rays that helps determine if patients with knee pain are candidates for total knee arthroplasty (TKA), unicompartmental knee arthroplasty (UKA), or are not arthroplasty candidates., Methods: Analysis was performed using radiographic and surgical data from a high-volume joint replacement practice. The dataset included 3 different X-ray views (anterior-posterior, lateral, and sunrise) for 2,767 patients along with information of whether that patient underwent an arthroplasty surgery (UKA or TKA) or not. This resulted in a dataset including 8,301 images from 2,707 patients. This dataset was then split into a training set (70%) and holdout test set (30%). A computer vision model was trained using a transfer learning approach. The performance of the computer vision model was evaluated on the holdout test set. Accuracy and multiclass receiver operating characteristic area under curve was used to evaluate the performance of the model., Results: The artificial intelligence model achieved an accuracy of 87.8% on the holdout test set and a quadratic Cohen's kappa score of 0.811. The multiclass receiver operating characteristic area under curve score for TKA was calculated to be 0.97; for UKA a score of 0.96 and for No Surgery a score of 0.98 was achieved. An accuracy of 93.8% was achieved for predicting Surgery versus No Surgery and 88% for TKA versus not TKA was achieved., Conclusion: The artificial intelligence/machine learning model demonstrated viability for predicting which patients are candidates for a UKA, TKA, or no surgical intervention., (Copyright © 2022 Elsevier Inc. All rights reserved.)

Introduction: Isolated tibial polyethylene insert exchange (ITPIE) as a treatment for instability and polyethylene wear after total knee arthroplasty (TKA) remains controversial with studies reporting varied results. The purpose of this study is to evaluate the survival and outcomes of ITPIE performed for treatment of instability with or without polyethylene wear after TKA., Materials and Methods: A query of a private practice arthroplasty registry revealed 364 patients (390 knees) treated with ITPIE for instability and/or polyethylene wear after TKA between 1997 and 2019. Mean age was 66.8 years, mean body mass index (BMI) was 33.8 kg/m2, and 59% of patients were female. ITPIE for infection, tibiofemoral aseptic loosening, arthrofibrosis, poor wound healing, and extensor mechanism failure were excluded. All patients had well-fixed and well-aligned components prior to surgery., Results: Mean follow up was 5.9 years. Knee Society Clinical (KSC) scores improved preoperatively from 55 to 76 postoperatively (p <0.001). Thirty knees (7.7%) required re-revision: 15 (3.8%) for ongoing instability, seven aseptic loosening, three infection, two patellofemoral maltracking, one patellar fracture, one metal allergy, and one revised elsewhere for cause unknown. Kaplan-Meier analysis revealed survival of 93.1% (95% CI: ±1.5%) at five years, 84.7% (95% CI: ±3.5%) at 10 years, and 80.5% (95% CI: ±4.4%) at 21 years., Conclusions: ITPIE is a reliable treatment for instability and/or polyethylene wear after TKA in the presence of well-fixed and well-aligned components with good survival and clinical improvement. The less invasive nature and reduced risk for bone loss make it an attractive option versus full revision.

Introduction: For much of recent history, the metal-bearing surface in total knee arthroplasty has not changed much, with cobalt-chromium being the most widely-used material. However, due to the presence of nickel in its composition, much research has been done to develop alternative metal-bearing surfaces for patients with metal sensitivity. Titanium nitride coatings have shown improved performance and resistance to abrasive wear when compared to their counterparts, thus making this material an ideal alternative to current implant technology., Materials and Methods: Rigorous testing was undertaken to analyze the mechanical properties of titanium nitride for use as a coating in orthopedic implants, such as scratch adhesion, hardness, modulus, and wear rates with specialized machinery, including a Tribometer®, Nano Indenter® G200 (KLA Corporation, Milpitas, California), and scratch system., Results: Across all properties tested-abrasive wear resistance, wear resistance, cohesive and adhesive failure load, hardness, and modulus-IBED TiN coatings were shown to be dominant to both uncoated CoCr and uncoated Ti-6Al-4V in a significant manner., Conclusion: The use of IBED TiN coatings offers a way to improve the performance of mechanical components, such as orthopedic implants made from Ti-6Al-4V materials. IBED TiN coatings can enable the use of Ti-6Al-4V as an alternative to CoCr for articulating orthopedic implant devices, such as knee arthroplasty.