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Background: The split anconeus fascia transfer (SAFT) is an option for reconstruction of the lateral ulnar collateral ligament (LUCL) in chronic posterolateral rotatory instability (PLRI) of the elbow with potential advantages of using only local tissue within the surgical exposure and not requiring ulnar fixation. This study aimed to assess SAFT strength compared to a traditional free graft reconstruction in a PLRI biomechanical model. Methods: To measure biomechanical strength, eight cadaveric upper extremity pairs were utilized. Within each pair, one specimen was randomly assigned to LUCL reconstruction with autograft palmaris longus and the other to SAFT reconstruction. Torque load to failure was assessed on a load frame with the elbow in 30 degrees of flexion, 5 degrees of valgus, and 25 N axial load as the elbow was brought into external rotation. Torque load to failure was compared between the two reconstruction techniques. Results: No difference was found in the torque load to failure between SAFT specimens compared to palmaris longus autograft specimens (mean 14.6 ± 4.4 Nm vs. mean 11.3 ± 3.9 Nm; P = .16). Discussion: In this biomechanical study, the SAFT LUCL reconstruction provided torque load to failure similar to that of the traditional technique. These findings suggest that the SAFT technique warrants continued study as a biomechanically sound option for LUCL reconstruction in the setting of elbow PLRI.

Deficits in memory performance have been linked to a wide range of neurological and neuropsychiatric conditions. While many studies have assessed the memory impacts of individual conditions, this study considers a broader perspective by evaluating how memory recall is differentially associated with nine common neuropsychiatric conditions using data drawn from 55 international studies, aggregating 15,883 unique participants aged 15–90. The effects of dementia, mild cognitive impairment, Parkinson’s disease, traumatic brain injury, stroke, depression, attention-deficit/hyperactivity disorder (ADHD), schizophrenia, and bipolar disorder on immediate, short-, and long-delay verbal learning and memory (VLM) scores were estimated relative to matched healthy individuals. Random forest models identified age, years of education, and site as important VLM covariates. A Bayesian harmonization approach was used to isolate and remove site effects. Regression estimated the adjusted association of each clinical group with VLM scores. Memory deficits were strongly associated with dementia and schizophrenia (p < 0.001), while neither depression nor ADHD showed consistent associations with VLM scores (p > 0.05). Differences associated with clinical conditions were larger for longer delayed recall duration items. By comparing VLM across clinical conditions, this study provides a foundation for enhanced diagnostic precision and offers new insights into disease management of comorbid disorders.

The current study explores the use of computer vision and artificial intelligence (AI) methods for analyzing 360-degree spherical video-based virtual reality (SVVR) data. The study aimed to explore the potential of AI, computer vision, and machine learning methods (including entropy analysis, Markov chain analysis, and sequential pattern mining), in extracting salient information from SVVR video data. The research questions focused on differences and distinguishing characteristics of autistic and neurotypical usage characteristics in terms of behavior sequences, object associations, and common patterns, and the extent to which the predictability and variability of findings might distinguish the two participant groups and provide provisional insights into the dynamics of their usage behaviors. Findings from entropy analysis suggest the neurotypical group showed greater homogeneity and predictability, and the autistic group displayed significant heterogeneity and variability in behavior. Results from the Markov Chains analysis revealed distinct engagement patterns, with autistic participants exhibiting a wide range of transition probabilities, suggesting varied SVVR engagement strategies, and with the neurotypical group demonstrating more predictable behaviors. Sequential pattern mining results indicated that the autistic group engaged with a broader spectrum of classes within the SVVR environment, hinting at their attraction to a diverse set of stimuli. This research provides a preliminary foundation for future studies in this area, as well as practical implications for designing effective SVVR learning interventions for autistic individuals.

Category: Hindfoot; Basic Sciences/Biologics Introduction/Purpose: Primary repair of mid-substance Achilles tendon rupture may be performed using an open or a percutaneous technique. Previous meta-analyses of clinical data comparing the two techniques have demonstrated mostly equivalent functional outcomes and re-rupture rates. Individual cadaveric studies have also compared the biomechanical properties of the two approaches. However, the results of these studies have been heterogeneous, and there is currently no consensus as to whether one technique may be biomechanically superior. The purpose of this meta-analysis was to evaluate the biomechanical properties of open versus percutaneous Achilles tendon repair. Methods: A systematic review of original research articles was performed using PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. To qualify for study inclusion, articles were required to be published in English, utilized a cadaveric laboratory design, and had to directly compare the biomechanical properties of open Achilles repair using a Krackow or Kessler technique versus percutaneous repair using either the PARS (Arthrex) or Achillon (Integra) tendon repair systems. Evaluated outcomes included displacement (mm), load to failure (N), and stiffness (N/m). Results: Nine studies met inclusion criteria, including 190 cadaveric specimens (open: 83, PARS: 56; Achillon: 51) that underwent primary mid-substance Achilles tendon repair. Pooled analysis demonstrated no statistically significant difference in displacement (p = 0.418; Figure 1), load to failure (p = 0.923; Figure 2), or stiffness (p = 0.195; Figure 3) between the open and percutaneous techniques. Among the percutaneous approaches, there was no difference in displacement (p = 0.109; Figure 4) between the PARS and Achillon tendon repair systems. Conclusion: The results of this study suggest that both open and percutaneous techniques are biomechanically viable approaches for primary mid-substance Achilles tendon repair. These biomechanical findings must be interpreted in the context of clinical outcomes data as well as the differing complication profiles of the two techniques to best inform the surgical decision-making process for primary mid-substance Achilles tendon repair.

Purpose: To report the clinical outcomes of quadriceps tendon repair using adjustable cortical fixation devices at a minimum 2-year follow-up. Methods: A retrospective chart review identified patients who underwent quadriceps tendon repair using adjustable cortical fixation devices between January 2017 and March 2020. Patients with a partial tendon rupture were excluded. Demographic and injury-specific variables were gathered preoperatively and postoperatively from the electronic medical record and patient-reported outcomes (Lysholm Knee Questionnaire, Lower Extremity Functional Scale, and SF-12) were collected via telephone at a minimum of 2 years postoperatively. Results: Fourteen quadriceps tendon repairs were included in a total of 13 patients. The average time to follow-up was 3.5 ± 1.2 years with a range of 1.9 to 5.7 years. The mean age of this cohort was 55.7 ± 11.6 years, and the mean body mass index was 32.9 ± 6.0. Ten injuries (71.4%) were sustained by mechanical fall, 2 patients (14.3%) suffered a direct blow to the knee, and 2 patients (14.3%) reported a noncontact injury mechanism. Thirteen quadriceps ruptures (13/14, 92.9%) underwent surgery within 10 days of their injury. One knee (7.1%) had a postoperative extensor lag of 5°, whereas another knee (7.1%) required a reoperation for manipulation under anesthesia and arthroscopic lysis of adhesions at 3 months’ postoperatively. None of the included patients (0.0%) developed a tendon re-rupture, venous thromboembolism, delayed wound healing, surgical-site infection, neuropraxia or nerve injury, hardware irritation, patella fracture, or heterotopic ossification. Conclusions: In this study, adjustable cortical fixation was a safe and effective surgical technique for quadriceps tendon repair, with adequate restoration of quadriceps function and a low rate of adverse events at 2 years postoperatively. Level of Evidence: Level IV, therapeutic case series.

Abstract Introduction This study sought to identify how diabetes organisations conceptualize the problem of diabetes‐related stigma and how this shapes the selection of stigma‐reduction interventions. Methods A qualitative deliberative democratic methodology was used to access an informed dialogue about what should be done by diabetes organisations to address diabetes‐related stigma, drawing from the perspectives of board members, healthcare services staff, and communications and marketing staff from a single state‐wide diabetes organisation in Australia (n = 25). Results Participants navigated the stigma concept along two axes: one that drew attention to either disease attributes or personal moral attributes as the object of stigmatisation, and one that positioned stigma as an individual or structural problem. This shaped the selection of stigma‐reduction interventions, which included interventions to: (i) reduce the prevalence of stigmatized attributes, (ii) correct misunderstandings about diabetes, (iii) modify representations of persons with diabetes, (iii) enhance coping amongst persons with diabetes and (iv) make healthcare more person‐centred and democratic. Conclusion This study identified several grievances with ‘diabetes‐related stigma’, which are grievances that can be conceptualized and addressed at both individual and structural levels, and involve correcting misinformation about diabetes or challenging and communicating alternative representations of persons living with diabetes. Patient or Public Contribution The organisation's management and board were consulted throughout all stages of research development, analysis and reporting. The information and vignettes presented to participants drew from illness narratives obtained from earlier research involving adults with type 2 diabetes. Research participants included adults with various diabetes types.

This study explored how to program for generalization using a fully immersive virtual reality (VR) intervention for teaching transportation skills to autistic adults related to using a university shuttle. Using multi-methods, this research sought to identify similarities and differences in behavior between the VR environment and the real-world, participants’ perceptions of telepresence in the VR environment, and how participants characterized similarities and differences between the VR environment and the real-world. Male adult participants (N ​= ​6) completed training and then engaged in two VR-based training sessions of increasing complexity, after which they enacted what was learned in the real-world. Fidelity of implementation was high across VR and real-world sessions and no significant differences were found in behaviors between the VR and real-world sessions, providing evidence for skills generalization from the contrived VR setting to the naturalistic real-world setting. Participants reported high perceptions of telepresence (e.g., being there) and social presence (e.g., being there with others), and qualitative evidence suggests they made connections between the virtual world and real-world. Implications and directions for future research are discussed.

Abstract Introduction HIV pre‐exposure prophylaxis (PrEP) has been government subsidized in Australia since April 2018 and while uptake is high among men who have sex with men, rates of discontinuation are also high. The aims of this study were to examine the impact of discontinuation on overall PrEP usage, the proportion of PrEP users who discontinue and the predictors of discontinuation. Methods We used linked de‐identified dispensing records of all government subsidized PrEP in Australia between April 2018 and September 2021: a whole‐of‐population data set. Defining discontinuation as 180 days or more without PrEP after the final dispensed supply, we calculated the number of people who discontinued at each 6‐month interval during the study period, the proportion who had discontinued 2 years after the first supply and, using Cox regression, predictors of discontinuation. Results Of 49,164 people dispensed PrEP (98.5% male, median age 34 years), 40.3% (19,815) had discontinued by September 2021. Within 2 years of their first supply, 11,150 (37.7%) of 29,549 PrEP users had discontinued, including 10.0% after a single dispensed supply. Large variations were observed, particularly according to prescriber characteristics: discontinuation was higher among people prescribed PrEP by low caseload (≤10 patients) prescribers (61.2%) than by high caseload (>100 patients) prescribers (31.1%, p5%) prevalence (36.7%, p

Introduction: South Australia has to date (October 2021) been highly successful in maintaining an aggressive suppression strategy for the management of the COVID-19 pandemic. However, continued success of this strategy is dependent on ongoing testing by people with symptoms of COVID-19 to identify, trace and quarantine emergent cases as soon as possible. This study sought to explore community members’ decisions about having COVID-19 testing in an environment of low prevalence, specifically exploring their decision-making related to symptoms. Materials and methods: This study drew on a qualitative case study design, involving five focus groups, conducted in May 2021, with 29 individuals who had experienced COVID-19-like symptoms since the commencement of testing in South Australia. Participants detailed their last COVID-19-like illness episode and described their decision-making regarding testing. Data collection methods and analysis were theoretically informed by the capability, opportunity, and motivation behaviour (COM-B) model. Findings: Participants' belief that COVID-19 symptoms would be ‘unusual’, severe, and persistent caused them to either reject or delay testing. Participants generally employed ‘watch and wait’ and social distancing behaviour rather than timely presentation to testing. Concern about economic loss associated with isolating after testing, and the potential for illness transmission at testing centres further prevented testing for some participants. Conclusions: In a low COVID-19 prevalence environment, individuals rely on pre-existing strategies for interpreting and managing personal illness (such as delaying help seeking if symptoms are mild), which generally conflict with public health management advice about COVID-19. In low prevalence environments therefore public health authorities must give the public a reason to test beyond considerations of personal risk, and clearly communicate the need for ongoing COVID-19 surveillance despite the low prevalence environment.

The purpose of this study was to use the Altmetric Attention Score to determine the 50 most impactful medial ulnar collateral ligament articles in online media and compare their characteristics to the most-cited medial ulnar collateral ligament articles in the scientific literature. The Altmetric database was queried to identify all published articles about the medial ulnar collateral ligament, and this list was stratified by the Altmetric Attention Score to identify the 50 highest scoring articles. Several data elements were extracted, including article topic, article type, journal name, and the number of online mentions on Facebook, Twitter, news, and other platforms. Each article’s geographic origin was determined based on the institutional affiliation of the first author. Our index search yielded 1283 articles published between 1987 and 2020, from which the 50 articles with the highest Altmetric Attention Scores were included for analysis. Altmetric Attention Scores of the top 50 medial ulnar collateral ligament articles ranged from 20 to 482 (median: 32, interquartile range: 20–62). The most common article type was original research (72%), and the most common topic was epidemiology/risk factors (26%). A majority of studies were Level 3 (36%) or Level 4 evidence (36%). Of the top 50 medial ulnar collateral ligament articles, 94% originated from the United States. A few articles had a high Altmetric Attention Score, suggesting that medial ulnar collateral ligament research does not generate consistently high online attention. The lack of Level 1 studies suggests the need for high-level studies on the medial ulnar collateral ligament. Most studies originated in the United States and were published in the American Orthopaedic Society for Sports Medicine–affiliated journals. The medial ulnar collateral ligament articles included in this study differed substantially from a previous report of the most-cited medial ulnar collateral ligament articles in the literature, suggesting that alternative metrics add a unique dimension to understanding the overall impact of published research on the medial ulnar collateral ligament.

Background: Some cultural and social factors may discourage the use of modern family planning (MFP) methods. The purpose of this study was to better understand the barriers and social norms that might affect women’s ability to take optimal advantage of the free family planning services offered by the Jordanian Ministry of Health (MOH). Methods: Using a qualitative descriptive design, 7 focus group discussions were conducted from January to February 2018, with a purposive sample of 52 married women. Each group consisted of 6-12 participants. Ethical approvals were obtained. Data were analysed using inductive thematic analysis. Results: Data analysis revealed three main themes and four subthemes. The first theme ‘conforming to social and cultural norms’ included the following subthemes: ‘to conform to family and social pressure to bear children’ and ‘to prioritize having male children’. The second theme ‘unmet needs in expected family planning counselling’ included the following subthemes: ‘need for consistency across providers in family planning counselling’, and ‘need for follow-up counselling’. The third theme was the ‘undesirable side-effects’ of the MFP methods, which included both the ‘experienced’ and the ‘anticipated’ side effects. Conclusion: This study identified a number of women’s perceived barriers to using MFP methods. These included conforming to the social pressure, inconsistency of the counselling process, and undesirable side effects. Their perspectives should be carefully addressed in any family planning program.

Objectives: To identify the top 100 most impactful anterior cruciate ligament articles in online media as measured by the Altmetric Attention Score and compare their characteristics to the most-cited anterior cruciate ligament articles in the scientific literature. Methods: The Altmetric database was queried to identify all published articles pertaining to the anterior cruciate ligament. The search yielded 9445 articles, which were stratified by highest to lowest Altmetric Attention Score. The top 100 articles were included. Collected data included article type, article topic, journal name, and online mentions in news, blogs, Twitter, Facebook, Wikipedia, and other sources. The geographic origin of each article was also determined based on the institutional affiliation of the first author. Results: Altmetric Attention Score of the top 100 anterior cruciate ligament articles ranged from 109 to 2193 (median 172.0, interquartile range 137.5–271.5). Of the 100 articles, 65 were published in three journals: American Journal of Sports Medicine, British Journal of Sports Medicine, and Journal of Orthopaedic & Sports Physical Therapy. The most prevalent article type was original research (60%), followed by systematic review/meta-analysis (18%). The most prevalent article topic was rehabilitation and return to play after anterior cruciate ligament reconstruction (22%), followed by epidemiology/risk factors (16%), injury prevention (14%), and biomechanics of anterior cruciate ligament injuries (14%). Of the top 100 articles, 54% were American, 31% were European, and 15% were published in other countries outside of the United States and Europe. Conclusion: This study used Altmetric Attention Score to identify the 100 most engaged anterior cruciate ligament articles in online media. The characteristics of these articles differed substantially from the most-cited anterior cruciate ligament articles in the literature with regard to article type, article topic, geographic origin, and publication journal. These findings suggest that alternative metrics measure distinct components of anterior cruciate ligament article engagement and add an important dimension to understanding the overall impact of published research on the anterior cruciate ligament.

Purpose: The purpose of our study is to identify the location of the posterior femoral cutaneous nerve (PFCN) and its branches in relation to the proximal hamstring tendon. Methods: Fifteen lower torso human cadaveric specimens were dissected in prone position. Skin and subcutaneous tissues were reflected to expose the gluteal and hamstring musculature. The distance between the ischial tuberosity and lateral border of the hamstring, PFCN, perineal branch of the PFCN, and descending femoral branch of the PFCN was measured with digital calipers. Measurements were repeated three times and averaged. Results: The PFCN was 30.5 ± 11.4 mm lateral to the central tip of the ischial tuberosity (range: 15.7 to 52.0 mm). The average longitudinal distance from the tip of the ischial tuberosity to the point where the perineal branch crossed the hamstrings was 24.1 ± 15.0 mm (range: 9.9 to 52.2 mm). The average longitudinal distance to the point where the descending cutaneous branch crossed the hamstrings was 83.3 ± 21.3 mm (range: 41.3 to 110.3 mm). The PFCN was nearest to the inferior border of the gluteus maximus 45.8 ± 13.6 mm lateral to the ischial tuberosity (range: 13.6 to 62.1 mm). Eleven specimens (73%) had one identifiable perineal branch; four (27%) had two distinct perineal branches. Conclusions: The PFCN was in close proximity to the surgical approach used during proximal hamstring repair, with the perineal branch consistently crossing the surgical field transversely. The location of these nerves varied substantially among the specimens tested, with some nerves less than 1 cm from the ischial tuberosity and 27% of specimens with two perineal branches.

This article draws on the researcher’s training and experience as a certified intimacy coordinator to examine how labour from professional sex work to intimacy coordination necessitates nuanced approaches to consent. What I call consent work – practices of communication, negotiation, and boundary setting – supports bodily autonomy while guiding portrayals of intimacy and nudity in film, television, theatre, and erotic media. I begin by discussing intimacy coordinators’ communication and consent frameworks to create context for my ensuing investigation. Next, utilizing data from interviews with online sex workers, I explore their sophisticated personal and community-oriented harm reduction techniques that, without formal training, dovetail with those in the intimacy coordination industry. Continuing my qualitative analysis, I describe the ways in which my interlocutors’ use of knowledge from consensual BDSM reflects the breadth of practices that inform consent work while illuminating the links between kink and intimacy coordination. Finally, I unpack how consent models remain entangled within systems of inequality and exclusion while owing much to marginalized communities’ contributions to contemporary understandings of bodily autonomy. Overall, consent work and its capacious lineage contribute to the expanding literature on intimacy coordination and highlight the field’s under-researched intersections with adult content creation.

BACKGROUND: Clinical trials are increasingly using Bayesian methods for their design and analysis. Inference in Bayesian trials typically uses simulation-based approaches such as Markov Chain Monte Carlo methods. Markov Chain Monte Carlo has high computational cost and can be complex to implement. The Integrated Nested Laplace Approximations algorithm provides approximate Bayesian inference without the need for computationally complex simulations, making it more efficient than Markov Chain Monte Carlo. The practical properties of Integrated Nested Laplace Approximations compared to Markov Chain Monte Carlo have not been considered for clinical trials. Using data from a published clinical trial, we aim to investigate whether Integrated Nested Laplace Approximations is a feasible and accurate alternative to Markov Chain Monte Carlo and provide practical guidance for trialists interested in Bayesian trial design. METHODS: Data from an international Bayesian multi-platform adaptive trial that compared therapeutic-dose anticoagulation with heparin to usual care in non-critically ill patients hospitalized for COVID-19 were used to fit Bayesian hierarchical generalized mixed models. Integrated Nested Laplace Approximations was compared to two Markov Chain Monte Carlo algorithms, implemented in the software JAGS and stan, using packages available in the statistical software R. Seven outcomes were analysed: organ-support free days (an ordinal outcome), five binary outcomes related to survival and length of hospital stay, and a time-to-event outcome. The posterior distributions for the treatment and sex effects and the variances for the hierarchical effects of age, site and time period were obtained. We summarized these posteriors by calculating the mean, standard deviations and the 95% equitailed credible intervals and presenting the results graphically. The computation time for each algorithm was recorded. RESULTS: The average overlap of the 95% credible interval for the treatment and sex effects estimated using Integrated Nested Laplace Approximations was 96% and 97.6% compared with stan, respectively. The graphical posterior densities for these effects overlapped for all three algorithms. The posterior mean for the variance of the hierarchical effects of age, site and time estimated using Integrated Nested Laplace Approximations are within the 95% credible interval estimated using Markov Chain Monte Carlo but the average overlap of the credible interval is lower, 77%, 85.6% and 91.3%, respectively, for Integrated Nested Laplace Approximations compared to stan. Integrated Nested Laplace Approximations and stan were easily implemented in clear, well-established packages in R, while JAGS required the direct specification of the model. Integrated Nested Laplace Approximations was between 85 and 269 times faster than stan and 26 and 1852 times faster than JAGS. CONCLUSION: Integrated Nested Laplace Approximations could reduce the computational complexity of Bayesian analysis in clinical trials as it is easy to implement in R, substantially faster than Markov Chain Monte Carlo methods implemented in JAGS and stan, and provides near identical approximations to the posterior distributions for the treatment effect. Integrated Nested Laplace Approximations was less accurate when estimating the posterior distribution for the variance of hierarchical effects, particularly for the proportional odds model, and future work should determine if the Integrated Nested Laplace Approximations algorithm can be adjusted to improve this estimation.

Previous studies have reported alterations in cortical thickness in autism. However, few have included enough autistic females to determine if there are sex specific differences in cortical structure in autism. This longitudinal study aimed to investigate autistic sex differences in cortical thickness and trajectory of cortical thinning across childhood. Participants included 290 autistic (88 females) and 139 nonautistic (60 females) individuals assessed at up to 4 timepoints spanning ~2-13 years of age (918 total MRI timepoints). Estimates of cortical thickness in early and late childhood as well as the trajectory of cortical thinning were modeled using spatiotemporal linear mixed effects models of age-by-sex-by-diagnosis. Additionally, the spatial correspondence between cortical maps of sex-by-diagnosis differences and neurotypical sex differences were evaluated. Relative to their nonautistic peers, autistic females had more extensive cortical differences than autistic males. These differences involved multiple functional networks, and were mainly characterized by thicker cortex at ~3 years of age and faster cortical thinning in autistic females. Cortical regions in which autistic alterations were different between the sexes significantly overlapped with regions that differed by sex in neurotypical development. Autistic females and males demonstrated some shared differences in cortical thickness and rate of cortical thinning across childhood relative to their nonautistic peers, however these areas were relatively small compared to the widespread differences observed across the sexes. These results support evidence of sex-specific neurobiology in autism and suggest that processes that regulate sex differentiation in the neurotypical brain contribute to sex differences in the etiology of autism.

Clara Carreras-Abad,1,2 Laxmee Ramkhelawon,1 Paul T Heath,1 Kirsty Le Doare1,3,4 1Paediatric Infectious Diseases Research Group and Vaccine Institute, Institute for Infection and Immunity, St George’s, University of London, London, UK; 2Department of Paediatrics, Obstetrics and Gynecology and Preventive Medicine and Public Health, Universitat Autònoma de Barcelona, Barcelona, Spain; 3Pathogen Immunity Group, Public Health England, Porton Down,UK; 4Medical Research Council/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine, Uganda Research Unit, Entebbe, UgandaCorrespondence: Clara Carreras-AbadPaediatric Infectious Diseases Research Group, Institute for Infection and Immunity, St George’s, University of London, Jenner Wing, Level 2 Mailpoint J2C, Cranmer Terrace, London SW17 0RE, UKEmail ccarrera@sgul.ac.ukAbstract: Group B streptococcus (GBS) causes a high burden of neonatal and infant disease globally. Implementing a vaccine for pregnant women is a promising strategy to prevent neonatal and infant GBS disease and has been identified as a priority by the World Health Organisation (WHO). GBS serotype-specific polysaccharide – protein conjugate vaccines are at advanced stages of development, but a large number of participants would be required to undertake Phase III clinical efficacy trials. Efforts are therefore currently focused on establishing serocorrelates of protection in natural immunity studies as an alternative pathway for licensure of a GBS vaccine, followed by Phase IV studies to evaluate safety and effectiveness. Protein vaccines are in earlier stages of development but are highly promising as they might confer protection irrespective of serotype. Further epidemiological, immunological and health economic studies are required to enable the vaccine to reach its target population as soon as possible.Keywords: Group B streptococcus, Streptococcus agalactiae, maternal vaccines, maternal immunisation, neonatal sepsis, infant sepsis

We examined academic advisors' clinically significant symptoms of major depressive disorder (MDD) and generalized anxiety disorder (GAD), including whether there are statistically significant relationships between advisors' demographic characteristics, work-related variables, institutional variables, burnout, resilience, and risk of clinically significant MDD/GAD symptoms. We analyzed survey data of academic advisors collected from February to March 2023 (n = 777) and found that 16.9% of advisors met the criteria for MDD while 29.6% met the criteria for GAD, rates higher than national averages. While there were some demographic differences, advisors who experienced higher rates of burnout had increased odds of experiencing MDD and GAD symptoms. In addition, advisors' resilience was associated with decreased odds of experiencing MDD and GAD symptoms.

Self-regulated learning (SRL) is associated with university student academic success outcomes, however students often need support to develop these skills. Technology-mediated feedback is one strategy that may aid educators in supporting students' SRL development. This study aims to explore whether a technology-mediated feedback strategy targeting tutorial preparation for flipped classrooms enhances first-year students' self-report SRL and observed implementation of the strategy. Self-report SRL was measured using the Motivated Strategies for Learning Questionnaire (MSLQ); strategy implementation profiles were based on lecture video access patterns. First-year psychology students (n = 99) were sent technology-mediated feedback emails aimed at developing their SRL. Paired-samples t-tests revealed significant increases in post-intervention self-reported motivational SRL subscales; self-reported and observed learning strategies implementation did not improve. Future research could build upon this exploratory work to form a multi-pronged strategy to increase understanding of the role of technology-mediated feedback in first-year students' SRL development for flipped classroom learning.

Abstract Purpose The purpose of our study was to use the Altmetric Attention Score (AAS) to evaluate the 100 most impactful articles in online media pertaining to the rotator cuff and compare their characteristics to the most‐cited rotator cuff articles in the scientific literature. Methods We performed an article extraction using Altmetric Explorer to identify all published articles pertaining to the rotator cuff. The top 100 articles with the highest AAS were included for analysis. Several data elements were extracted for each included article: title, article type, article topic, year of publication, journal name, authors, institutional affiliations, and online mentions (i.e. the number of times the article was mentioned in news, blog, Twitter, Facebook, and Wikipedia sources). The geographic origin of each article was also determined by the institutional affiliation of the first author, which was categorized as American (originating in the United States), European (originating in Europe), or other. Results The 100 articles with the highest AAS were published between 2009 and 2020, with AAS ranging from 47 to 676 (median: 74.5, 25th percentile: 59.5, 75th percentile: 114.5). Of all online media sources, Twitter correlated most strongly with AAS (r = 0.9007, r2 = 0.8112). The selected articles were most frequently published in the American Journal of Sports Medicine (13), the Journal of Shoulder and Elbow Surgery (11), and the Journal of Bone and Joint Surgery (7). The most common article type was Systematic Review/Meta‐Analysis (29%), followed by Randomized Controlled Trial (15%). The top 3 AAS articles were all published by authors based in Europe. Conclusion The most impactful rotator cuff articles in online media generated substantial online attention. These studies were often performed in Europe and tended to be high level of evidence, focusing on treatment of rotator cuff pathology. The rotator cuff articles that produced the most online attention differed from a previous report of the most‐cited rotator cuff articles, suggesting that alternative metrics may be used in concert with conventional bibliometrics to obtain a more complete representation of scientific impact.

Category: Sports Introduction/Purpose: Artificial turf (AT) playing surfaces have emerged as a common alternative to natural grass (NG) at all levels of athletic competition from youth to professional. While several prior articles have compared the lower extremity injury rates on AT and NG, the heterogeneity of these studies in terms of design and methodology has led to widely variable results. The purpose of this systematic review was to determine whether any definitive conclusions can be drawn with regard to the risk of lower extremity injury on AT and NG playing surfaces. Methods: A systematic review of the English-language literature was performed according to the PRISMA guidelines. All included studies presented a direct comparison of injury rates on AT versus NG playing surfaces. No restrictions were made with regard to sport, level of competition, level of evidence, or year of publication. Studies that examined only head injury rates (e.g. concussions) without any comparison of overall injury rates or lower extremity injury rates were excluded. Systematic reviews and meta-analyses were also excluded. The following data elements were extracted from each article: publication year, study design, level of evidence, industry funding, cohort selection process (ad-hoc vs. systematic), sport, level of competition, number of athletic seasons, injury setting, AT type, overall injury rate, knee rate, and foot & ankle injury rate. AT types were classified into Old Generation (1st or 2nd generation) or New Generation (3rd generation or higher). Results: 53 articles met inclusion criteria. 31 articles compared overall injury rates on AT versus NG. Roughly one-half of these studies (51.6%) found no significant difference between NG and AT, while roughly one-third (35.5%) found a higher overall injury rate on AT and just 4 studies (12.9%) found a higher overall injury rate on NG. Similarly, of the 26 articles comparing knee injury rates, 14 studies (53.8%) reported no difference between AT and NG, 8 studies (30.8%) reported a higher injury rate on AT, and 4 studies (15.4%) reported a higher injury rate on NG. With regard to foot & ankle injuries, however, a majority of articles (14/24, 58.3%) reported a higher injury rate on AT. Comparatively few articles (3/24, 12.5%) reported a higher foot & ankle injury rate on NG, while the remaining articles (7/24, 29.2%) reported no difference in foot & ankle injury rate between AT and NG. Conclusion: The present study is a systematic review of 53 articles in the English-language literature that compared injury rates on AT and NG. Our findings suggest that the rates of overall injury and knee injury are similar between these two playing surfaces, though AT may be associated with a higher rate of foot & ankle injuries compared to NG.

Category: Ankle; Hindfoot; Sports Introduction/Purpose: Achilles tendon injuries affect a wide range of individuals, including both recreational and competitive athletes. In the elite athlete population, Achilles tendon ruptures are typically season-ending injuries and can be career-threatening. Due to these impacts on individual players' careers as well as team success, Achilles tendon injuries often generate substantial discussion in the mainstream media and among the general public. However, traditional citation-based metrics fail to capture the dissemination of Achilles research that occurs outside the realm of scientific journal publications. Thus, the purpose of this study was to use the Altmetric Attention Score (AAS) to identify the 100 most impactful articles in online media pertaining to the Achilles tendon and assess their characteristics. Methods: The Altmetric database (Digital Science, Holtzbrinck Publishing) was queried to identify all published articles pertaining to the Achilles Tendon. The articles were stratified by highest to lowest AAS and the top 100 articles with the highest scores were included for analysis. Several data elements were extracted for each article: title, article type, article topic, year of publication, journal name, authors, institutional affiliations, and online mentions (i.e., the number of times the article was mentioned in news, blog, Twitter, Facebook and Wikipedia sources). The geographic origin of each article was also determined by the institutional affiliation of the first author, which was categorized as American (originating in the United States), European (originating in Europe), or Other. Linear regression was used to determine the relationship between online mentions and AAS. Results: The initial search yielded 3,810 articles published between 1957 and 2021. AAS of the top 100 articles ranged from 37 to 476 with a median of 65 (interquartile range: 42-110). The selected articles were published in 39 journals. The most prevalent article type was randomized controlled trial (21.8%), followed by systematic review / meta-analysis (13.9%). The most prevalent article topics were treatment (39.6%), rehabilitation and return to play (11.9%), epidemiology (11.9%), and biomechanics (11.9%). Of the top 100 articles, 25.0% were American, 45.0% were European, and 30.0% were published outside of the United States or Europe. AAS had a strong correlation to Twitter mentions (r = 0.81), a moderate correlation to Google Scholar mentions (r = 0.52), and a weak correlation to Facebook mentions (r = 0.49). Conclusion: This study used AAS to characterize the 100 most impactful Achilles articles in online media. As access to research continues to move away from the conventional printed format, it is critically important to understand how orthopaedic information is disseminated online. Our findings suggest that alternative metrics broaden the definition of article impact beyond what is provided by traditional citation-based metrics and should be considered as a supplemental means of assessing the overall impact of published scientific literature.

Case. A 74-year-old female developed left shoulder pain after receiving an influenza vaccine. Her initial physical exam was suggestive of subacromial bursitis, and a corticosteroid injection into the subacromial space resulted in a 50% improvement in her pain. Subsequent MRI demonstrated myositis isolated to the infraspinatus muscle. She was successfully treated with anti-inflammatory medication and physical therapy. Conclusion. Shoulder injury related to vaccine administration (SIRVA) is a rare clinical complication, and myositis in the rotator cuff musculature has not been previously reported. Proper administration of intramuscular vaccinations should be emphasized to prevent injury to structures surrounding the shoulder joint.

Background: Stroke survivors are at high risk of dementia, associated with increasing age and vascular burden and with pre-existing cognitive impairment, older age. Brain atrophy patterns are recognised as signatures of neurodegenerative conditions, but the natural history of brain atrophy after stroke remains poorly described. We sought to determine whether stroke survivors who were cognitively normal at time of stroke had greater total brain (TBV) and hippocampal volume (HV) loss over 3 years than controls. We examined whether stroke survivors who were cognitively impaired (CI) at 3 months following their stroke had greater brain volume loss than cognitively normal (CN) stroke participants over the next 3 years.Methods: Cognition And Neocortical Volume After Stroke (CANVAS) study is a multi-centre cohort study of first-ever or recurrent adult ischaemic stroke participants compared to age- and sex-matched community controls. Participants were followed with MRI and cognitive assessments over 3 years and were free of a history of cognitive impairment or decline at inclusion. Our primary outcome measure was TBV change between 3 months and 3 years; secondary outcomes were TBV and HV change comparing CI and CN participants. We investigated associations between group status and brain volume change using a baseline-volume adjusted linear regression model with robust standard error.Results: Ninety-three stroke (26 women, 66.7 ± 12 years) and 39 control participants (15 women, 68.7 ± 7 years) were available at 3 years. TBV loss in stroke patients was greater than controls: stroke mean (M) = 20.3 cm3 ± SD 14.8 cm3; controls M = 14.2 cm3 ± SD 13.2 cm3; [adjusted mean difference 7.88 95%CI (2.84, 12.91) p-value = 0.002]. TBV decline was greater in those stroke participants who were cognitively impaired (M = 30.7 cm3; SD = 14.2 cm3) at 3 months (M = 19.6 cm3; SD = 13.8 cm3); [adjusted mean difference 10.42; 95%CI (3.04, 17.80), p-value = 0.006]. No statistically significant differences in HV change were observed.Conclusions: Ischaemic stroke survivors exhibit greater neurodegeneration compared to stroke-free controls. Brain atrophy is greater in stroke participants who were cognitively impaired early after their stroke. Early cognitive impairment was associated greater subsequent atrophy, reflecting the combined impacts of stroke and vascular brain burden. Atrophy rates could serve as a useful biomarker for trials testing interventions to reduce post-stroke secondary neurodegeneration.Clinical Trail Registration:http://www.clinicaltrials.gov, identifier: NCT02205424.

The predominance of western paradigms and a frequent failure to consider and theorize the non-neutrality of schools and technology leaves an ontological and epistemological gap in educational technology studies. Specifically, it leads to thin research on the role of power, the collective, and the intersections with technology that can alter our interaction with the world. The current narrow approach hobbles the imagination of the field, constraining the possibilities for technology and education. We propose three research frames that are relatively new to the field of educational technology. These frames acknowledge the interdisciplinary and socially embedded nature of technology and the systems of power that exist in both schools and technology: "Collective Framing, Critical Race Theory (CRT) Framing," and "Ecological Framing." We synthesize the possibilities of these approaches for educational technology research, identifying how they can push the field to consider different epistemological, ontological, and axiological approaches. We identify potential areas of research and consider implications for the field of educational technology. While each frame offers its particular theoretical contribution, taken together, all three frames suggest the sociocultural, epistemological, and political limitations of the field known as educational technology. Finally, we return to the initial wonderings of our paper, imagining the possibilities for ed tech research if the field confronted the hegemonic western paradigms embedded within itself.

In this pilot study, we report on the feasibility, acceptability and potential impact of 'Who, When, How to Share', a new disclosure decision-making programme for autistic adults. We evaluated this programme using pre-post mixed-methods surveys that included questions about participants' experiences of the programme and four psychosocial outcome measures. While 32 autistic adults completed the pre-programme survey and enrolled into the programme, there was high attrition, with only 19 autistic adults completing the programme and post-programme survey. We found that it was feasible to deliver the programme in a guided self-help format, although a minority of participants (who completed the programme or provided reasons for withdrawing from the programme) found it challenging to work through the programme independently and within the study time frame. High levels of satisfaction and positive qualitative feedback also suggested that the programme was acceptable to autistic adults. Participants provided useful recommendations for improvement, such as more interactive elements to enhance engagement. The programme showed potential to improve decisional conflict, disclosure-related distress, stigma-related stress and internalised stigma among autistic adults, though further evaluation of the impact of the programme is needed.

Whole genome sequences (WGS) enable discovery of rare variants which may contribute to missing heritability of coronary artery disease (CAD). To measure their contribution, we apply the GREML-LDMS-I approach to WGS of 4949 cases and 17,494 controls of European ancestry from the NHLBI TOPMed program. We estimate CAD heritability at 34.3% assuming a prevalence of 8.2%. Ultra-rare (minor allele frequency ≤ 0.1%) variants with low linkage disequilibrium (LD) score contribute ~50% of the heritability. We also investigate CAD heritability enrichment using a diverse set of functional annotations: i) constraint; ii) predicted protein-altering impact; iii) cis-regulatory elements from a cell-specific chromatin atlas of the human coronary; and iv) annotation principal components representing a wide range of functional processes. We observe marked enrichment of CAD heritability for most functional annotations. These results reveal the predominant role of ultra-rare variants in low LD on the heritability of CAD. Moreover, they highlight several functional processes including cell type-specific regulatory mechanisms as key drivers of CAD genetic risk.

Can increasing women’s use of digital financial services raise their empowerment? We test this hypothesis using a randomized control trial with 152 female microfinance groups in Tanzania, where treated groups were randomly switched to repay their loan using mobile money instead of cash. This exogenous shift in women’s use of mobile money for loan repayment substantially increases their use for other types of transactions. Women’s control over their finances increases, they have higher levels of empowerment in the household and expenditures shift towards goods plausibly aligned with their preferences. These findings highlight the benefits of greater use of digital technologies for women.

Human cell line models, including the neuronal precursor line LUHMES, are important for investigating developmental transcriptional dynamics within imprinted regions, particularly the 15q11-q13 Angelman (AS) and Prader-Willi (PWS) syndrome locus. AS results from loss of maternal UBE3A in neurons, where the paternal allele is silenced by a convergent antisense transcript UBE3A-ATS, a lncRNA that terminates at PWAR1 in non-neurons. qRT-PCR analysis confirmed the exclusive and progressive increase in UBE3A-ATS in differentiating LUHMES neurons, validating their use for studying UBE3A silencing. Genome-wide transcriptome analyses revealed changes to 11 834 genes during neuronal differentiation, including the upregulation of most genes within the 15q11-q13 locus. To identify dynamic changes in chromatin loops linked to transcriptional activity, we performed a HiChIP validated by 4C, which identified two neuron-specific CTCF loops between MAGEL2-SNRPN and PWAR1-UBE3A. To determine if allele-specific differentially methylated regions (DMR) may be associated with CTCF loop anchors, whole genome long-read nanopore sequencing was performed. We identified a paternally hypomethylated DMR near the SNRPN upstream loop anchor exclusive to neurons and a paternally hypermethylated DMR near the PWAR1 CTCF anchor exclusive to undifferentiated cells, consistent with increases in neuronal transcription. Additionally, DMRs near CTCF loop anchors were observed in both cell types, indicative of allele-specific differences in chromatin loops regulating imprinted transcription. These results provide an integrated view of the 15q11-q13 epigenetic landscape during LUHMES neuronal differentiation, underscoring the complex interplay of transcription, chromatin looping, and DNA methylation. They also provide insights for future therapeutic approaches for AS and PWS.

Effective transport of biological systems as cargo during space travel is a critical requirement to use synthetic biology and biomanufacturing in outer space. Bioproduction using microbes will drive the extent to which many human needs can be met in environments with limited resources. Vast repositories of biological parts and strains are available to meet this need, but their on-site availability requires effective transport. Here, we explore an approach that allows DNA plasmids, ubiquitous synthetic biology parts, to be safely transported to the International Space Station and back to the Kennedy Space Center without low-temperature or cryogenic stowage. Our approach relied on the cyanobacterium Nostoc punctiforme PC73102, which is naturally tolerant to prolonged desiccation. Desiccated N. punctiforme was able to carry the non-native pSCR119 plasmid as intracellular cargo safely to space and back. Upon return to the laboratory, the extracted plasmid showed no DNA damage or additional mutations and could be used as intended to transform the model synbio host Escherichia coli to bestow kanamycin resistance. This proof-of-concept study provides the foundation for a ruggedized transport host for DNA to environments where there is a need to reduce equipment and infrastructure for biological parts stowage and storage.

Understanding the normal function of the Huntingtin (HTT) protein is of significance in the design and implementation of therapeutic strategies for Huntington's disease (HD). Expansion of the CAG repeat in the HTT gene, encoding an expanded polyglutamine (polyQ) repeat within the HTT protein, causes HD and may compromise HTT's normal activity contributing to HD pathology. Here, we investigated the previously defined role of HTT in autophagy specifically through studying HTT's association with ubiquitin. We find that HTT interacts directly with ubiquitin in vitro. Tandem affinity purification was used to identify ubiquitinated and ubiquitin-associated proteins that copurify with a HTT N-terminal fragment under basal conditions. Copurification is enhanced by HTT polyQ expansion and reduced by mimicking HTT serine 421 phosphorylation. The identified HTT-interacting proteins include RNA-binding proteins (RBPs) involved in mRNA translation, proteins enriched in stress granules, the nuclear proteome, the defective ribosomal products (DRiPs) proteome and the brain-derived autophagosomal proteome. To determine whether the proteins interacting with HTT are autophagic targets, HTT knockout (KO) cells and immunoprecipitation of lysosomes were used to investigate autophagy in the absence of HTT. HTT KO was associated with reduced abundance of mitochondrial proteins in the lysosome, indicating a potential compromise in basal mitophagy, and increased lysosomal abundance of RBPs which may result from compensatory up-regulation of starvation-induced macroautophagy. We suggest HTT is critical for appropriate basal clearance of mitochondrial proteins and RBPs, hence reduced HTT proteostatic function with mutation may contribute to the neuropathology of HD.