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Brown and brown-like adipose tissues have attracted significant attention for their role in metabolism and therapeutic potential in diabetes and obesity. Despite compelling evidence of an interplay between adipocytes and lymphocytes, the involvement of these tissues in immune responses remains largely unexplored. This study explicates a newfound connection between neuroinflammation and brown- and bone marrow adipose tissue. Leveraging the use of [18F]F-AraG, a mitochondrial metabolic tracer capable of tracking activated lymphocytes and adipocytes simultaneously, we demonstrate, in models of glioblastoma and multiple sclerosis, the correlation between intracerebral immune infiltration and changes in brown- and bone marrow adipose tissue. Significantly, we show initial evidence that a neuroinflammation-adipose tissue link may also exist in humans. This study proposes the concept of an intricate immuno-neuro-adipose circuit, and highlights brown- and bone marrow adipose tissue as an intermediary in the communication between the immune and nervous systems. Understanding the interconnectedness within this circuitry may lead to advancements in the treatment and management of various conditions, including cancer, neurodegenerative diseases and metabolic disorders.

Abstract Brown and brown-like adipose tissues have attracted significant attention for their role in metabolism and therapeutic potential in diabetes and obesity. Despite compelling evidence of an interplay between adipocytes and lymphocytes, the involvement of these tissues in immune responses remains largely unexplored. This study explicates a newfound connection between neuroinflammation and brown- and bone marrow adipose tissue. Leveraging the use of [18F]F-AraG, a mitochondrial metabolic tracer capable of tracking activated lymphocytes and adipocytes simultaneously, we demonstrate, in models of glioblastoma and multiple sclerosis, the correlation between intracerebral immune infiltration and changes in brown- and bone marrow adipose tissue. Significantly, we show initial evidence that a neuroinflammation-adipose tissue link may also exist in humans. This study proposes the concept of an intricate immuno-neuro-adipose circuit, and highlights brown- and bone marrow adipose tissue as an intermediary in the communication between the immune and nervous systems. Understanding the interconnectedness within this circuitry may lead to advancements in the treatment and management of various conditions, including cancer, neurodegenerative diseases and metabolic disorders.

Aims The aims of the study were to illustrate the number and type of restrictive practices that were used across two inpatient wards within the Acute Mental Health Inpatient Centre in the Belfast trust over a two year period. This initially would highlight the prevalence and use of such practices and allow for comparison against the data collected after the implementation of the therapy cross. We hoped that with the implementation of the therapy cross we would see a decline in the use of physical interventions, use of IM medications and also the number of aggressive or distressing incidents and behaviours would also decrease. Methods We utilized a statistical process control to collate and illustrate data. Daily data collection was carried out and compiled over a 2–3 year period and is ongoing with regards to ward incidents of aggressive behaviour, use of physical intervention, use of IM medications. In early October of 2023 the therapy cross was introduced and the run charts and data collection continued allowing for comparison of such behaviours and interventions pre and post intervention. Results A percentage decrease of 50% of the weekly average was noted in incidents of aggressive and violent behaviours on one ward in AMHIC following implementation of therapy. A percentage decrease in average weekly use of IM injections was noted to be 13%. A 12% decrease was found in the use of physical intervention on a weekly average following the therapy cross. Conclusion The implementation of a therapy cross in early October 2023 indicated improvement in the incidence of use of restrictive measures on two inpatient wards in the Belfast Trust, including the number of physical interventions such as holds that were required and also decreased the incidence of use of IM medications for rapid tranquillization. The data indicates a significant decrease in the number of cases of violent and aggressive behaviour on wards following implementation of a therapy cross.

Abstract Aim To evaluate emergency obstetric care education and training within a medical assistant training program, being delivered in a remote, fragile region of Southeast Asia. This will aid in the identification of potential areas of enhancement to improve the management of obstetric emergencies. Design An ethnographic study, adopting a multi‐methods approach. Methods Emergency obstetric care education and training will be assessed through documentary analysis and interviews (online or face‐to‐face) with educators and trainers (N ~ 6–7). Student experiences will be explored using in‐person focus groups, facilitated by an external trainer involved in delivering the program (N ~ 10–12). A reflective field diary will provide insight into the lived experience of postgraduate students (N ~ 4–5). Data will be collected between May 2022 and May 2023. The full data set will be triangulated and analysed using the READ approach; (1) ready your materials, (2) extract data, (3) analyse data and (4) distil your findings. Institutional ethical approval was obtained from a university in October 2021, and inter‐country regional access was gained following adherence to their local ethical requirements. Implications for the Profession and Patient Care The findings from this study may help to inform the future design of the medical assistant training program. It is anticipated that the knowledge gained from this study will enhance the education and training of mid‐level health providers at local, national, and international levels. This work intends to contribute to addressing Sustainable Development Goal 3, Target 1 of reducing maternal mortality to 70:100,000 live births in low‐income countries. Reporting Method This protocol adhered to the Standards for Reporting Qualitative Research (SRQR) checklist. Patient or Public Contribution No formal PPI has been undertaken; however, stakeholders involved in delivering the education and training have been consulted.

Category: Midfoot/Forefoot; Other Introduction/Purpose: The primary goal of treating hallux rigidus of the 1st metatarsophalangeal (MTP) joint of the foot is to reduce pain. Treatment options include cheilectomy, interposition arthroplasty, and arthrodesis for more severe disease. Recently, the use of a synthetic cartilage implant (Cartiva, Stryker Inc., MI, USA) has been introduced with the advantage of motion preservation. While a Level 1 study has demonstrated similar outcomes of fusion and Cartiva, other comparative studies have shown less favorable results for the Cartiva implant. The purpose of this study was to evaluate minimum 2-year patient reported outcomes (PROs) of the Cartiva implant for the treatment of hallux rigidus in the 1st MTP joint in comparison to a matched cohort of patients treated with fusion or cheilectomy. Methods: Patients >18 years old who underwent surgery for treatment of 1st MTP joint hallux rigidus with Cartiva implant, cheilectomy, or fusion performed by two surgeons (T.O.C. or C.T.H.) between January 2009 and January 2020 were identified. A 2:1 matched control cohort of patients who underwent cheilectomy or fusion was constructed using a nearest neighbor, greedy algorithm based on age, sex, prior surgery, and Coughlin osteoarthritis grade. Minimum 2-year follow-up was obtained with patients completing subjective questionnaires including Foot and Ankle Ability Measure (FAAM) with Activities of Daily Living (ADL) and Sport subscales, Short Form-12 (SF-12), Tegner activity scale, and patient satisfaction with surgical outcome. Demographics and patient-reported outcomes were compared between groups. Results: Follow-up was obtained for 22/27 (82%) Cartiva patients (mean age 54±19) at median 4.3 years and 41/49 (84%) control patients (mean age 58±11) at median 3.5 years. Prevalence of Coughlin grade was similar between Cartiva and control groups (6 vs 10 grade 1, 8 vs 15 grade 2, 2 vs 6 grade 4, 6 vs 10 grade 5; p=.93), respectively. There was no significant difference in median post-operative FAAM-ADL (96 vs 95, p=.53), FAAM-Sport (92 vs 89, p=.89), SF-12 PCS (56 vs 51, p=.054), SF-12 MCS (56.3 vs 57.5, p=.50), Tegner score (4 vs 3, p=.30), or patient satisfaction (9 vs 9, p=.91) between Cartiva and control cohorts, respectively. Revision surgery was required for 3 (14%) Cartiva patients and 4 (10%) control patients (p=.70). Conclusion: Patients treated with a Cartiva synthetic cartilage implant for 1st MTP joint hallux rigidus had similar patient-reported outcomes and revision rate compared to patients treated with cheilectomy or fusion for Coughlin grade 2-5 osteoarthritis.

Background The purpose of this study is to explore the professional and personal experiences of multidisciplinary healthcare professionals during and following diabetes counselling and empowerment-based education. Methods Everyone who had participated in a diabetes counselling and empowerment course between 2008-2016 was invited to respond to an online survey and follow-up telephone interview if willing. Interviews were recorded and transcribed verbatim. The research team used interpretative phenomenology to identify core themes from both the survey and telephone interviews and which captured the impact of empowerment-based education. Results 22 doctors, nurses, dieticians, and psychologists completed an online questionnaire. 10 subsequently took part in telephone interviews. Empowerment-based education changed them from fixers to facilitators. Their transformation included a sense of becoming authentic, ‘being the way I want to be’ in clinical practice and becoming more self-reflective. This affected them personally as well as reinvigorating them professionally. Conclusions The participants described a personal and professional journey of transformation that included discovering their person-centred philosophy. They adopted a consultation structure that empowered people with diabetes to care for themselves. It can be speculated that participants’ experience of transformation may also guard against professional burnout.

IntroductionThe Manchester Clinical Placement Index (MCPI) is an instrument to measure medical undergraduates’ real-patient learning in communities of practice both in hospital and in GP placements. Its suitability to evaluate the quality of placement learning environments has been validated in an English-language context; however, there is a lack of evidence for its applicability in other languages. Our aim was to thoroughly explore the factor structure and the key psychometric properties of the Hungarian language version.MethodsMCPI is an 8-item, mixed-method instrument which evaluates the quality of clinical placements as represented by the leadership, reception, supportiveness, facilities and organization of the placement (learning environment) as well as instruction, observation and feedback (training) on 7-point Likert scales with options for free-text comments on the strengths and weaknesses of the given placement on any of the items. We collected data online from medical students in their preclinical (1st, 2nd) as well as clinical years (4th, 5th) in a cross-sectional design in the academic years 2019–2020 and 2021–2022, by the end of their clinical placements. Our sample comprises data from 748 medical students. Exploratory and confirmatory factor analyses were performed, and higher-order factors were tested.ResultsAlthough a bifactor model gave the best model fit (RMSEA = 0.024, CFI = 0.999, and TLI = 0.998), a high explained common variance (ECV = 0.82) and reliability coefficients (ωH = 0.87) for the general factor suggested that the Hungarian version of the MCPI could be considered unidimensional. Individual application of either of the subscales was not supported statistically due to their low reliabilities.DiscussionThe Hungarian language version of MCPI proved to be a valid unidimensional instrument to measure the quality of undergraduate medical placements. The previously reported subscales were not robust enough, in the Hungarian context, to distinguish, statistically, the quality of learning environments from the training provided within those environments. This does not, however, preclude formative use of the subscales for quality improvement purposes.

Inositol hexakisphosphate kinases (IP6Ks) are emerging as relevant pharmacological targets because a multitude of disease-related phenotypes has been associated with their function. While the development of potent IP6K inhibitors is gaining momentum, a pharmacological tool to distinguish the mammalian isozymes is still lacking. Here, we implemented an analog-sensitive approach for IP6Ks and performed a high-throughput screen to identify suitable lead compounds. The most promising hit, FMP-201300, exhibited high potency and selectivity toward the unique valine gatekeeper mutants of IP6K1 and IP6K2, compared to the respective wild-type (WT) kinases. Biochemical validation experiments revealed an allosteric mechanism of action that was corroborated by hydrogen deuterium exchange mass spectrometry measurements. The latter analysis suggested that displacement of the αC helix, caused by the gatekeeper mutation, facilitates the binding of FMP-201300 to an allosteric pocket adjacent to the ATP-binding site. FMP-201300 therefore serves as a valuable springboard for the further development of compounds that can selectively target the three mammalian IP6Ks; either as analog-sensitive kinase inhibitors or as an allosteric lead compound for the WT kinases.

We have developed a novel method of determining 2D radial density profiles for astronomical systems of discrete objects using Voronoi tessellations. This Voronoi-based method was tested against the standard annulus-based method on five simulated systems of objects, following known Hubble density profiles of varying parameters and sizes. It was found that the Voronoi-based method returned radial density fits with lower uncertainties on the fitting parameters across all five systems compared to the annulus-based method. The Voronoi-based method also consistently returned more accurate estimates of the total number of objects in each system than the annulus-based method, and this accuracy increased with increasing system size. Finally, the Voronoi-based method was applied to two observed globular cluster systems around brightest cluster galaxies ESO 444-G046 and 2MASX J13272961-3123237 and the results were compared to previous results for these galaxies obtained with the annulus-based method. Again, it was found that the Voronoi-based method returned fits with lower uncertainties on the fitting parameters, and the total number of globular clusters returned are within errors of the annulus-based method estimates, however also with lower uncertainties.

The use of accelerated beams of electrons, protons or ions has furthered the development of nearly every scientific discipline. However, high-energy muon beams of equivalent quality have not yet been delivered. Muon beams can be created through the decay of pions produced by the interaction of a proton beam with a target. Such 'tertiary' beams have much lower brightness than those created by accelerating electrons, protons or ions. High-brightness muon beams comparable to those produced by state-of-the-art electron, proton and ion accelerators could facilitate the study of lepton-antilepton collisions at extremely high energies and provide well characterized neutrino beams1-6. Such muon beams could be realized using ionization cooling, which has been proposed to increase muon-beam brightness7,8. Here we report the realization of ionization cooling, which was confirmed by the observation of an increased number of low-amplitude muons after passage of the muon beam through an absorber, as well as an increase in the corresponding phase-space density. The simulated performance of the ionization cooling system is consistent with the measured data, validating designs of the ionization cooling channel in which the cooling process is repeated to produce a substantial cooling effect9-11. The results presented here are an important step towards achieving the muon-beam quality required to search for phenomena at energy scales beyond the reach of the Large Hadron Collider at a facility of equivalent or reduced footprint6.

Off-the-job faculty development for clinical teachers has been blighted by poor attendance, unsatisfactory sustainability, and weak impact. The faculty development literature has attributed these problems to the marginalisation of the clinical teacher role in host institutions. By focusing on macro-organisational factors, faculty development is ignoring the how clinical teachers are shaped by their everyday participation in micro-organisations such as clinical teams. We set out to explore how the roles of clinical teacher and graduate learner are co-constructed in the context of everyday work in clinical teams. Using an ethnographic study design we carried out marginal participant observation of four different hospital clinical teams. We assembled a dataset comprising field notes, participant interviews, images, and video, which captured day-to-day working and learning encounters between team members. We applied the dramaturgical sensitising concepts of impression management and face work to a thematic analysis of the dataset. We found that learning in clinical teams was largely informal. Clinical teachers modelled, but rarely articulated, an implicit curriculum of norms, standards and expectations. Trainees sought to establish legitimacy and credibility for themselves by creating impressions of being able to recognise and reproduce lead clinicians' standards. Teachers and trainees colluded in using face work strategies to sustain favourable impressions but, in so doing, diminished learning opportunities and undermined educational dialogue. These finding suggest that there is a complex interrelationship between membership of clinical teams and clinical learning. The implication for faculty development is that it needs to move beyond its current emphasis on the structuring effects of institutional context to a deeper consideration of how teacher and learner roles are co-constructed in clinical teams.

Hypothesis: Both clinical outcomes and early rates of failure will not be associated with glenoid retroversion. Methods: All patients who underwent an anatomic total shoulder arthroplasty with minimal, noncorrective reaming between 2006 and 2016 with minimum 2-year follow-up were reviewed. Measurements for retroversion, inclination, and posterior subluxation were obtained from magnetic resonance imaging or computerized tomography. A regression analysis was performed to assess the association between retroversion, inclination and subluxation, and their effect on patient reported outcomes (PROs). Clinical failures and complications were reported. Results: One hundred fifty-one anatomic total shoulder arthroplasties (90% follow-up) with a mean follow-up of 4.6 years (range, 2-12 years) were assessed. The mean preoperative retroversion was 15.6° (range, 0.2-42.1), the mean posterior subluxation was 15.1% (range, −3.6 to 44.1%), and the mean glenoid inclination was 13.9° (range, −11.3 to 44.3). All median outcome scores improved significantly from pre- to post-operatively (P

Background: Excellent results have been reported for anatomic total shoulder arthroplasty (TSA) for the treatment of primary glenohumeral osteoarthritis (GHOA). We aim to assess the recovery curve and longitudinal effects of time, age, sex, and glenoid morphology on patient-reported outcomes (PROs) after primary anatomic TSA for primary GHOA. Methods: Patients who underwent primary anatomic TSA over 5 years ago were included: Short-Form 12 Physical Component Summary, American Shoulder and Elbow Surgeons scores, Quick Disabilities of the Arm Shoulder and Hand Score, Single Assessment Numeric Evaluation, and patient satisfaction were assessed. Linear mixed-effects models were used to model progression in PROs longitudinally. Unadjusted models and models controlling for sex and age were constructed. Results: Eighty-one patients (91 shoulders) were included. Significant improvements from the preoperative period to 1 year postoperatively in the median American Shoulder and Elbow Surgeons (48 to 93; P

The Muon Ionization Cooling Experiment (MICE) collaboration seeks to demonstrate the feasibility of ionization cooling, the technique by which it is proposed to cool the muon beam at a future neutrino factory or muon collider. The emittance is measured from an ensemble of muons assembled from those that pass through the experiment. A pure muon ensemble is selected using a particle-identification system that can reject efficiently both pions and electrons. The position and momentum of each muon are measured using a high-precision scintillating-fibre tracker in a 4 T solenoidal magnetic field. This paper presents the techniques used to reconstruct the phase-space distributions in the upstream tracking detector and reports the first particle-by-particle measurement of the emittance of the MICE Muon Beam as a function of muon-beam momentum.

Abstract Objectives To establish and validate a novel method for aligning femoral rotation to accurately measure femoral offset for preoperative templating and component sizing, and to identify the physical location of two radiographic lines utilized in the described method. Materials and methods Cadaveric proximal femurs were skeletonized and mounted to a biaxial load frame. Two radiographic lines along the greater trochanter were identified fluoroscopically. The femurs were rotated, and images were taken when the lines appeared superimposed, then in 2-degree increments to 10° of internal and external rotation, and at 30°. Radiographic femoral offset was calculated at each angle, and the maximum and aligned offsets were compared. Bone was removed until the radiographic lines disappeared, then a metal wire was inserted in place of the bone to confirm that the lines reappeared. Results The physical locations of the radiographic landmarks were on the anterior and posterior aspects of the greater trochanter. The mean true femoral offset was 38.2 mm (range, 30.5–46.3 mm). The mean aligned femoral offset was 37.3 mm (range, 29.3–46.3 mm), a 2.4% underestimation. The mean angle between aligned and true offset was 3.6° of external rotation (range, 10°ER-8°IR). Intra-rater intraclass correlation coefficient was 0.991. Conclusion Alignment of the radiographic lines created by the anterior and posterior aspects of the greater trochanter is a reliable and accurate rotational positioning method for measuring true femoral offset when using plain films or fluoroscopy, which can aid surgeons with preoperative templating and intraoperative component placement for total hip arthroplasty.

Objective To describe the extent to which older patients participate in discharge medication communication, and identify factors that predict patient participation in discharge medication communication.Design Observational study.Setting An Australian metropolitan tertiary hospital.Participants 173 older patients were observed undertaking one medication communication encounter prior to hospital discharge.Outcome Patient participation measured with MEDICODE, a valid and reliable coding framework used to analyse medication communication. MEDICODE provides two measures for patient participation: (1) Preponderance of Initiative and (2) Dialogue Ratio.Results The median for Preponderance of Initiative was 0.7 (IQR=0.5–1.0) and Dialogue Ratio was 0.3 (IQR=0.2–0.4), indicating healthcare professionals took more initiative and medication encounters were mostly monologue rather than a dialogue or dyad. Logistic regression revealed that patients had 30% less chance of having dialogue or dyads with every increase in one medication discussed (OR 0.7, 95% CI 0.5 to 0.9, p=0.01). Additionally, the higher the patient’s risk of a medication-related problem, the more initiative the healthcare professionals took in the conversation (OR 1.5, 95% CI 1.0 to 2.1, p=0.04).Conclusion Older patients are passive during hospital discharge medication conversations. Discussing less medications over several medication conversations spread throughout patient hospitalisation and targeting patients at high risk of medication-related problems may promote more active patient participation, and in turn medication safety outcomes.

Abstract Purpose The purpose of this study was to compare the biomechanical effect of in‐situ repair of posterior lateral meniscal root (PLMR) tear with segmental meniscal loss, with and without meniscofemoral ligament (MFL) imbrication, on anterior cruciate ligament (ACL) graft force and knee joint kinematics. Methods Ten fresh‐frozen cadaveric knee specimens underwent kinematic evaluation in five states: 1) Native, 2) ACLR, 3) Segmental PLMR loss, 4) In‐situ PLMR repair, and 5) MFL augmentation. Kinematic evaluation consisted of five tests, each performed at full extension and at 30° of flexion: 1) Anterior drawer, 2) Internal Rotation, 3) External Rotation, 4) Varus, and 5) Valgus. Additionally, a simulated pivot shift test was performed. Knee kinematics and ACL graft force were measured. Results PLMR tear did not significantly increase ACL graft force in any test. However, PLMR repair significantly reduced ACL graft force compared to the ACLR alone (over constraint ‐26.6 N, p = 0.001). PLMR tear significantly increased ATT during the pivot shift test (+ 2.7 mm, p = 0.0001), and PLMR repair restored native laxity. MFL augmentation did not improve the mechanics. Conclusions In‐situ PLMR repair eliminated pivot shift laxity through ATT and reduced force on the ACL graft, indicating that this procedure may be ACL graft‐protective. MFL augmentation was not shown to have any effect on graft force or knee kinematics and untreated PLMR tears may place an ACL graft at higher risk. This study suggests concomitant repair to minimize additional forces on the ACL graft.

The aim of this study was to define the minimal clinically important difference (MCID) values for patient-reported outcomes (PROs) after arthroscopic treatment of snapping scapula syndrome (SSS) using a distribution-based method, and to identify demographic, clinical, and intraoperative factors significantly associated with the achievement of MCID. It was hypothesized that subjective satisfaction scores after the procedure would be strongly associated with the achievement of MCID thresholds for the PROs and that pain, preoperative response to injection, and a scapulectomy in addition to bursal resection would be predictive of clinically relevant improvement. Patients who underwent arthroscopic treatment of SSS between October 2005 and September 2020 with a minimum of 2-year short-term postoperative follow-up were enrolled in this retrospective single-center study. The MCID was calculated using a distribution-based approach for the following PROs: 12-Item Short Form Health Survey (SF-12), American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form (ASES), Quick Disabilities of the Arm, Shoulder, and Hand questionnaire (QuickDASH), Single Assessment Numeric Evaluation (SANE), and visual analog scale (VAS) pain "today" and "at worst." The association between achievement of the MCID and postoperative subjective satisfaction was investigated, and factors associated with achievement of MCID were determined using bivariate analysis. Of a total of 190 patients assessed for eligibility, 77 patients (38.1 ± 14.3 years; 36 females) were included. Within the study population, statistically significant improvements in postoperative SF-12 physical component summary (PCS) (P <.001) and mental component summary (MCS) (P < 0.034), ASES (P <.001), QuickDASH (P <.001), SANE (P <.001), and VAS pain (P <.001) scores were observed at the minimum 2-year follow-up. The calculated MCID threshold values based on the study population were 5.0 for SF-12 PCS, 5.8 for SF-12 MCS, 11.3 for ASES, −10.5 for QuickDASH, 14.7 for SANE, 1.5 for VAS pain, and 1.7 for VAS pain at worst. Reaching the MCID was strongly associated with postoperative satisfaction (rated on a scale of 1-10). Across the PROs, younger age, favorable preoperative response to injection, partial scapuloplasty or scapulectomy, no prior surgery, and pain and function at baseline were significantly associated with attaining MCID. Patients who underwent arthroscopic treatment for SSS experienced clinically significant improvements in functional scores, pain, and quality of life. This study demonstrated predictive roles for certain patient-specific factors and diagnostic variables for achieving MCID in PROs, which may help surgeons preoperatively assess the probability of success and manage patient expectations. [ABSTRACT FROM AUTHOR]

Category: Ankle; Sports Introduction/Purpose: The Broström procedure is indicated for lateral ankle instability in the setting of acute or chronic ankle sprains, with injury of the anterior talofibular ligament (ATFL) being the most common. While the procedure is anatomically favorable, one disadvantage of the Broström procedure is significantly reduced strength of the repair when compared with the native ligament. Broström repair with augmentation of an InternalBrace (Arthrex, Naples, FL), nonabsorbable suture tape fixed directly to the bone, has demonstrated increased strength and stiffness of the repaired ATFL; however, there is a paucity of literature published on clinical outcomes. The purpose of this study is to compare clinical outcomes following treatment of ATFL injuries with Broström repair alone versus Broström repair with InternalBrace augmentation. Methods: Between January 2009 and December 2017, patients 18-75 years old who underwent surgical treatment for an ATFL injury of the lateral ankle injury with either a Broström repair alone (Cohort A) or Broström repair with InternalBrace augmentation (Cohort B) performed by two surgeons (TOC or CTH) and at least 2 years post-operative were identified. Minimum 2-year follow-up was obtained with patients completing subjective questionnaires including Foot and Ankle Ability Measure (FAAM) with Activities of Daily Living (ADL) and Sport subscales, Short Form-12 (SF-12) Mental Component Summary (MCS) and Physical Component Summary (PCS), Tegner activity scale, and patient satisfaction with surgical outcome. Demographics and patient-reported outcomes were compared between groups. Results: In total, 103 patients were included in the study. Cohort A had 54 patients (29 females) with median age of 32 (range: 19 to 68) and 49 of 54 patients (91%) completed follow-up at an median of 2.32 years (range: 2 to 12 years). Cohort B had 49 patients (29 females) with median age of 37 (range: 18 to 66) and 38 of 49 patients (78%) completed follow-up at an median of 3.07 years (range 2 to 7 years). There was no significant difference in age or sex between cohorts (p>0.05 for all). At earliest minimum 2-year follow-up, there was no significant difference in median post-operative FAAM ADL (97% vs 98%, p=0. 979), FAAM Sport (91% vs 91%, p=0.976), SF-12 PCS (56 vs 54, p=0.143), SF-12 MCS (56.6 vs 57.0, p=0.155), Tegner score (6 vs 5, p=0.214), or patient satisfaction (9 vs 9, p=0.781). Conclusion: Patients treated for ATFL injury of the lateral ankle with Broström repair with InternalBrace augmentation demonstrated similar clinical outcomes to those treated with Broström repair alone. With its advantages in strength and stiffness, the InternalBrace should be considered when treating lateral ankle instability in the setting of ligamentous injury since it allowed an earlier return to full weight bearing and a quicker rehabilitation protocol.

Background: High rates of secondary surgery after fixation of olecranon fractures have been reported. Identification of risk factors can aid surgeons to reduce complications leading to additional surgical procedures. Methods: Olecranon fractures treated at seven hospitals from 2007 to 2017 were identified, and the radiographs were classified. Isolated, displaced olecranon fractures treated operatively with tension band wiring (TBW) or precontoured plate fixation (PF) were reviewed. Adjusted risk factors for secondary surgery were analyzed, and a multivariable predictive model for secondary surgery was built. Results: After the initial review of 1259 olecranon fractures, 800 isolated, displaced olecranon fractures met the inclusion and exclusion criteria. The distribution of two-part and multifragmented fractures was equal. TBW was used in 636 patients and PF in 164 patients. Multifragmentation was a significant variable influencing preference for PF. Secondary surgery was performed in 41% patients and symptomatic hardware removal was the most frequent primary indication. In both the TBW and PF group, the rates of major complications leading to secondary surgery were 13% (P = .96). The adjusted risk of secondary surgery was lower with increasing age (odds ratio by 10 years increments, 0.74; 95% confidence interval, 0.68-0.80, P

Muon beams of low emittance provide the basis for the intense, well-characterized neutrino beams necessary to elucidate the physics of flavor at a neutrino factory and to provide lepton-antilepton collisions at energies of up to several TeV at a muon collider. The international Muon Ionization Cooling Experiment (MICE) aims to demonstrate ionization cooling, the technique by which it is proposed to reduce the phase-space volume occupied by the muon beam at such facilities. In an ionization-cooling channel, the muon beam passes through a material in which it loses energy. The energy lost is then replaced using rf cavities. The combined effect of energy loss and reacceleration is to reduce the transverse emittance of the beam (transverse cooling). A major revision of the scope of the project was carried out over the summer of 2014. The revised experiment can deliver a demonstration of ionization cooling. The design of the cooling demonstration experiment will be described together with its predicted cooling performance.

Abstract Background Maternal folic acid (FA) supplementation before and in early pregnancy prevents neural tube defects (NTD), but it is uncertain whether continuing FA after the first trimester has benefits on offspring health. We aimed to evaluate the effect of FA supplementation throughout pregnancy on cognitive performance and brain function in the child. Methods Follow-up investigation of 11-year-old children, residing in Northern Ireland, whose mothers had participated in a randomised trial of Folic Acid Supplementation in the Second and Third Trimesters (FASSTT) in pregnancy and received 400 μg/day FA or placebo from the 14th gestational week. Cognitive performance (Full Scale Intelligence Quotient, Verbal Comprehension, Working Memory, Perceptual Reasoning, and Processing Speed) was assessed using the Wechsler Intelligence Scale for Children. Neuronal function was assessed using magnetoencephalographic (MEG) brain imaging. Results Of 119 mother-child pairs in the FASSTT trial, 68 children were assessed for neurocognitive performance at 11-year follow-up (Dec 2017 to Nov 2018). Children of mothers randomised to FA compared with placebo scored significantly higher in two Processing Speed tests, i.e. symbol search (mean difference 2.9 points, 95% CI 0.3 to 5.5, p = 0.03) and cancellation (11.3 points, 2.5 to 20.1, p = 0.04), whereas the positive effect on Verbal Comprehension was significant in girls only (6.5 points, 1.2 to 11.8, p = 0.03). MEG assessment of neuronal responses to a language task showed increased power at the Beta (13–30 Hz, p = 0.01) and High Gamma (49–70 Hz, p = 0.04) bands in children from FA-supplemented mothers, suggesting more efficient semantic processing of language. Conclusions Continued FA supplementation in pregnancy beyond the early period currently recommended to prevent NTD can benefit neurocognitive development of the child. MEG provides a non-invasive tool in paediatric research to objectively assess functional brain activity in response to nutrition and other interventions. Trial registration ISRCTN ISRCTN19917787 . Registered on 15 May 2013.