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Applying biodegradable osteosyntheses avoids the disadvantages of titanium osteosyntheses. However, foreign-body reactions remain a major concern and evidence of complete resorption is lacking. This study compared the physico-chemical properties, histological response and radiographs of four copolymeric biodegradable osteosynthesis systems in a goat model with 48-months follow-up. The systems were implanted subperiosteally in both tibia and radius of 12 Dutch White goats. The BioSorb FX [poly(70LLA-co-30DLLA)], Inion CPS [poly([70–78.5]LLA-co-[16–24]DLLA-co-4TMC)], SonicWeld Rx [poly(DLLA)], LactoSorb [poly(82LLA-co-18GA)] systems and a negative control were randomly implanted in each extremity. Samples were assessed at 6-, 12-, 18-, 24-, 36-, and 48-month follow-up. Surface topography was performed using scanning electron microscopy (SEM). Differential scanning calorimetry and gel permeation chromatography were performed on initial and explanted samples. Histological sections were systematically assessed by two blinded researchers using (polarized) light microscopy, SEM and energy-dispersive X-ray analysis. The SonicWeld Rx system was amorphous while the others were semi-crystalline. Foreign-body reactions were not observed during the complete follow-up. The SonicWeld Rx and LactoSorb systems reached bone percentages of negative controls after 18 months while the BioSorb Fx and Inion CPS systems reached these levels after 36 months. The SonicWeld Rx system showed the most predictable degradation profile. All the biodegradable systems were safe to use and well-tolerated (i.e., complete implant replacement by bone, no clinical or histological foreign body reactions, no [sterile] abscess formation, no re-interventions needed), but nanoscale residual polymeric fragments were observed at every system's assessment.

Introduction: Temporomandibular joint (TMJ) osteoarthritis is a degenerative disease of the TMJ. It is characterized by progressive degradation of the extracellular matrix components of articular cartilage, with secondary inflammatory components leading to pain in the temporomandibular region and reduced mouth opening. Current treatments do not halt disease progression, hence the need for new therapies to reduce inflammation and, consequently, improve symptoms. The aim of our randomized controlled clinical trial protocol is to investigate the efficacy of adjuvant intra-articular injections of autologous tissue-like stromal vascular fraction (tSVF), compared to arthrocentesis alone, in reducing pain and improving mouth opening in TMJ osteoarthritis patients. Materials and Methods: The primary endpoint analysis will consist of the visual analogue scale (VAS) for pain. The secondary endpoint analyses will include maximal interincisal mouth opening measurements; assessment of oral health and mandibular function based on the oral health impact profile (OHIP) questionnaire and mandibular functional impairment questionnaire (MFIQ); complications during the follow up; synovial cytokine analysis at baseline and after 26 weeks; and nucleated cells and tSVF (immuno)histochemistry analyses of the intervention group. Discussion: Our randomized clinical trial protocol will be applied to evaluate the efficacy of a new promising tSVF injection therapy for TMJ osteoarthritis. The safety of intra-articular injections of tSVF has been proven for knee osteoarthritis. However, since a tSVF injection is considered a heterologous application of cell therapy, the regulatory requirements are strict, which makes medical ethical approval challenging.

Abstract Applying the right torque to osteosynthesis screws is important for undisturbed bone healing. This study aimed to compare test–retest and intra-individual reliabilities of the torque applied to 1.5 mm and 2.0 mm osteosynthesis screws by residents and oral and maxillofacial surgeons (OMF-surgeons), to define the reference torque intervals, and to compare reference torque interval compliances. Five experienced OMF-surgeons and 20 residents, 5 of each 4 residency years, were included. Each participant inserted six 1.5 × 4 mm and six 2.0 × 6 mm screws into a preclinical model at two test moments 2 weeks apart (T1 and T2). Participants were blinded for the applied torque. Descriptive statistics, reference intervals, and intra-class correlation coefficients (ICC) were calculated. The OMF-surgeons complied more to the reference intervals (1.5 mm screws: 95% and 2.0 mm screws: 100%) than the residents (82% and 90%, respectively; P = 0.009 and P = 0.007) with the ICCs ranging between 0.85–0.95 and 0.45–0.97, respectively. The residents’ accuracy and reliability were inadequate regarding the 1.5 mm screws but both measures improved at T2 for both screw types compared to T1, indicating a learning effect. Training residents and/or verifying the applied torque by experienced OMF-surgeons remains necessary to achieve high accuracy and reliability, particularly for 1.5 mm screws.

This paper presents the results of an exploration into the adoption of biodiversity-friendly practices by the real estate sector, by researching which factors determine companies’ intentions to use nature-inclusive design and construction concepts (NID). NID represents practices in which nature and building are inextricably linked when (re)designing building projects. We applied the Theory of Planned Behavior (TPB), a well-known framework for studying behavior. A telephone survey was carried out among 103 employees at different types of companies in the real estate sector. The findings showed that attitude, social norms, and perceived behavioral control are all significant explanatory variables for the intention of using NID. Perceived behavioral control is the strongest predictor. In addition, interest in NID strengthens the predictive value of perceived behavioral control. The empirical findings in this study serve as a first attempt to provide insights into the determinants of behavior in favor of using NID and, by extension, looking for drivers for change. The study was carried out in the Netherlands, but the results may be applicable or interesting to other countries as well when looking for opportunities to enhance biodiversity in urban areas or considering how the real estate sector could give substance to their vital role in spatial developments.

Introduction: Horizontal violence (HV) is malicious behavior perpetrated by healthcare workers against each other. These include bullying, verbal or physical threats, purposeful disruptive behavior, and other malicious behaviors. This pilot study investigates the prevalence of HV among emergency department (ED) attending physicians, residents, and mid-level providers (MLPs). Methods: We sent an electronic survey to emergency medicine attending physicians (n=67), residents (n=25), and MLPs (n=24) in three unique EDs within a single multi-hospital medical system. The survey consisted of 18 questions that asked participants to indicate with what frequency (never, once, a few times, monthly, weekly, or daily) they have witnessed or experienced a particular behavior in the previous 12 months. Seven additional questions aimed to elicit the impact of HV on the participant, the work environment, or the patient care. Results: Of the 122 survey invitations 91 were completed, yielding a response rate of 74.6%. Of the respondents 64.8% were male and 35.2% were female. Attending physicians represented 41.8%, residents 37.4%, and MLPs 19.8% of respondents. Prevalence of reported behaviors ranged from 1.1% (Q18: physical assault) to 34.1% (Q4: been shouted at). Fourteen of these behaviors were most prevalent in the attending cohort, six were most prevalent in the MLP cohort, and three of the behaviors were most prevalent in the resident cohort. Conclusion: The HV behaviors investigated in this pilot study were similar to data previously published in nursing cohorts. Furthermore, nearly a quarter of participants (22.2%) indicated that HV has affected care for their patients, suggesting further studies are warranted to assess prevalence and the impact HV has on staff and patients. [West J Emerg Med. 2017;18(2)213-218.]

Introduction: Temporomandibular joint (TMJ) osteoarthritis is a degenerative disease of the TMJ. It is characterized by progressive degradation of the extracellular matrix components of articular cartilage, with secondary inflammatory components leading to pain in the temporomandibular region and reduced mouth opening. Current treatments do not halt disease progression, hence the need for new therapies to reduce inflammation and, consequently, improve symptoms. The aim of our randomized controlled clinical trial protocol is to investigate the efficacy of adjuvant intra-articular injections of autologous tissue-like stromal vascular fraction (tSVF), compared to arthrocentesis alone, in reducing pain and improving mouth opening in TMJ osteoarthritis patients. Materials and Methods: The primary endpoint analysis will consist of the visual analogue scale (VAS) for pain. The secondary endpoint analyses will include maximal interincisal mouth opening measurements; assessment of oral health and mandibular function based on the oral health impact profile (OHIP) questionnaire and mandibular functional impairment questionnaire (MFIQ); complications during the follow up; synovial cytokine analysis at baseline and after 26 weeks; and nucleated cells and tSVF (immuno)histochemistry analyses of the intervention group. Discussion: Our randomized clinical trial protocol will be applied to evaluate the efficacy of a new promising tSVF injection therapy for TMJ osteoarthritis. The safety of intra-articular injections of tSVF has been proven for knee osteoarthritis. However, since a tSVF injection is considered a heterologous application of cell therapy, the regulatory requirements are strict, which makes medical ethical approval challenging. [ABSTRACT FROM AUTHOR]

Abstract Wearables offer a promising solution for enhancing remote monitoring (RM) of heart failure (HF) patients by tracking key physiological parameters. Despite their potential, their clinical integration faces challenges due to the lack of rigorous evaluations. This review aims to summarize the current evidence and assess the readiness of wearables for clinical practice using the Medical Device Readiness Level (MDRL). A systematic search identified 99 studies from 3112 found articles, with only eight being randomized controlled trials. Accelerometery was the most used measurement technique. Consumer-grade wearables, repurposed for HF monitoring, dominated the studies with most of them in the feasibility testing stage (MDRL 6). Only two of the described wearables were specifically designed for HF RM, and received FDA approval. Consequently, the actual impact of wearables on HF management remains uncertain due to limited robust evidence, posing a significant barrier to their integration into HF care.

Abstract Safeguarding the drinking water quality remains a challenge from the production site to the tap. Alternatively to chemical disinfection, biostable drinking water could serve as a more sustainable approach to produce microbially safe drinking water and to maintain the microbial quality in the drinking water distribution system (DWDS). In this study, the potential of hydrogen-oxidizing bacteria (HOB) to produce biostable drinking water was examined in a continuous trickling filter supplied with hydrogen gas. A biofilm was naturally enriched for 5 months and the bacterial regrowth, invasion potential, and nutrient composition of the water were determined. Treatment improved the biostability significantly, and it is hypothesized that nutrient limitation, especially phosphorous, was a driving force. As a result, the regrowth and invasion potential were lowered, as shown with specific biostability bioassays. Overall, this study demonstrates the proof-of-concept of HOB for producing biostable drinking water through nutrient limitation.

Abstract Background Only a few decades ago, colorful, small‐scale, heterogeneous, and species‐rich hay meadows or extensive pastures were common, but have often been replaced by species‐poor, uniform, large‐scale multicut meadows. Technological advancements and improved efficiency in grassland management have come at the cost of biodiversity. Methods In Germany, 150 grassland plots have been investigated since 2006. Using these extensive data, we propose a new compound index for estimating the site‐specific mowing intensity in order to facilitate assessment of the impact of mowing intensity on biodiversity and ecosystem processes. Our index integrates the various qualitative components of mowing machine type, mowing height and use of a conditioner, with the annual number of cuts. Results The newly proposed index achieves a much finer gradation of mowing intensity compared to the previous quantification based on the number of cuts only. Furthermore, a decrease in plant and arthropod species was observed at higher mowing intensity. Conclusions The proposed mowing intensity index offers enhanced precision in calculations and can easily be integrated into assessments of land‐use intensity in grasslands. Further, it could serve as a basis for providing subsidies to farmers, who adopt low‐impact mowing practices.

Abstract Background Patellar instability is a well-known pathology in which kinematics can be investigated using metrics such as tibial tuberosity tracheal groove (TTTG), the bisect offset (BO), and the lateral patellar tilt (LPT). We used dynamic computed tomography (CT) to investigate the patellar motion of healthy subjects in weight-bearing conditions to provide normative values for TTTG, BO, and LPT, as well as to define whether BO and LPT are affected by the morphology of the trochlear groove. Methods Dynamic scanning was used to acquire images during weight-bearing in 21 adult healthy volunteers. TTTG, BO, and LPT metrics were computed between 0° and 30° of knee flexion. Sulcus angle, sulcus depth, and lateral trochlear inclination were calculated and used with the TTTG for simple linear regression models. Results All metrics gradually decreased during eccentric movement (TTTG, -6.9 mm; BO, -12.6%; LPT, -4.3°). No significant differences were observed between eccentric and concentric phases at any flexion angle for all metrics. Linear regression between kinematic metrics towards full extension showed a moderate fit between BO and TTTG (R 2 0.60, β 1.75) and BO and LPT (R 2 0.59, β 1.49), and a low fit between TTTG and LPT (R 2 0.38, β 0.53). A high impact of the TTTG distance over BO was shown in male participants (R 2 0.71, β 1.89) and patella alta individuals (R 2 0.55, β 1.91). Conclusion We provided preliminary normative values of three common metrics during weight-bearing dynamic CT and showed the substantial impact of lateralisation of the patella tendon over patella displacement. Relevance statement These normative values can be used by clinicians when evaluating knee patients using TTTG, BO, and LPT metrics. The lateralisation of the patellar tendon in subjects with patella alta or in males significantly impacts the lateral displacement of the patella. Key Points Trochlear groove morphology had no substantial impact on motion prediction. The lateralisation of the patellar tendon seems a strong predictor of lateral displacement of the patella in male participants. Participants with patella alta displayed a strong fit between the patellar lateral displacement and tilt. TTTG, BO, and LPT decreased during concentric movement. Concentric and eccentric phases did not show differences for all metrics. Graphical Abstract

Abstract In this study, we analyze the effects of technology availability, political coordination, and behavioral change on transformation pathways toward net-zero greenhouse gas emissions in the European Union by 2050. We implemented an iterative stakeholder dialogue to co-design the scenarios that were calculated using a global multi-regional energy-economy-land-climate model. We find that in scenarios without behavioral change and with restriction of technologies, the target of greenhouse gas neutrality in the European Union cannot be reached. Already a target of 200 Mt CO2eq/yr requires CO2 prices above 100 €/tCO2 in 2030 across all sectors in all scenarios. The required CO2 price can increase to up to 450 €/tCO2 by 2030 if technologies are constrained, if no complementary regulatory measures are implemented, and if changes in consumer behavior towards a more sustainable lifestyle do not materialize.

Abstract This study utilized a pilot-scale distribution network to examine the impact of temperature increases (16 °C, 20 °C, 24 °C) and source variations (treated ground- and surface water) on bulk and biofilm communities over 137 days. Microbial characterization employed flow cytometry and 16 S rRNA gene-based amplicon sequencing to elucidate bulk-biofilm interactions. Bacterial bulk cell densities increased with higher temperatures, while water source variations significantly influenced bulk cell densities as well as the community composition. Additionally, growth curves were fitted on the flow cytometry results, and growth rates and carrying capacities were higher with treated groundwater at elevated temperatures. Conversely, biofilm cell densities remained unaffected by temperature. A mature biofilm was observed from day 70 onwards and a core biofilm microbiome, resilient to temperature and water source changes, was identified. These findings emphasize the importance of water source quality for maintaining biological stability in drinking water systems, particularly in the face of changing environmental conditions.

Abstract Smart charging of electric vehicles can alleviate grid congestion and reduce charging costs. However, various electric vehicle models currently lack the technical capabilities to effectively implement smart charging since they cannot handle charging pauses or delays. These models enter sleep mode when charging is interrupted, preventing resumption afterwards. To avoid this, they should be continuously charged with their minimum charging power, even when a charging pause would be desirable, for instance with high electricity prices. This research examines this problem to inform various stakeholders, including policymakers and manufacturers, and stimulates the adoption of proactive measures that address this problem. Here, we demonstrate through technical charging tests that around one-third of tested car models suffer from this issue. Through model simulations we indicate that eliminating paused and delayed charging problems would double the smart charging potential for all applications. Lastly, we propose concrete legal and practical solutions to eliminate these problems.